AR & Payor Relations Specialist

Pedes Orange County•Irvine, CA

About The Position

Pedes Orange County is seeking a detail-oriented AR & Payor Relations Specialist to oversee insurance follow-up, denial management, and cash collections for our growing vascular practice. This role is responsible for ensuring claims are processed accurately, denials are resolved efficiently, and revenue is collected in a timely manner to maintain healthy cash flow. In addition to leading AR operations, this position provides secondary support in payor credentialing and payor contracting to ensure uninterrupted billing capability and network participation across all service lines.

Requirements

2+ years of experience in medical billing, accounts receivable, revenue cycle, or insurance follow-up
Working knowledge of Medicare, Medi-Cal, Medicare Advantage, and commercial payer reimbursement
Familiarity with ICD-10, CPT, HCPCS, EOBs, and remittance advice
Experience with payer portals, clearinghouses, and EHR/practice management systems
Strong organizational skills, follow-through, and problem-solving ability

Nice To Haves

College Degree or 2+ years of Relevant Experience
Payor Credentialing or Contracting Certification

Responsibilities

Assist with payment posting and tracking
Perform follow-up on unpaid, underpaid, and rejected insurance claims
Resolve claim denials through correction, resubmission, and formal appeals
Reconcile bank accounts
Contact insurance carriers via phone and payer portals to resolve claim discrepancies
Verify payment accuracy against contracted fee schedules
Assist patients with billing questions, balances, and payment arrangements
Document all payer and patient communications in the billing system
Review EOBs and remittance advice for accuracy
Ensure correct use of CPT, ICD-10, and HCPCS coding in coordination with clinical and billing teams
Provide reporting on AR metrics, denial categories, and payer performance
Escalate systemic reimbursement issues to leadership
Assist with Medicare, Medi-Cal, Medicare Advantage, and commercial payer enrollments
Support payor credentialing applications and re-credentialing processes at the organizational/group level
Track payer contract expirations and renewals
Support communication with payers, IPAs, and facilities regarding participation status
Maintain organized payor credentialing and contracting documentation
Maintain accurate AR documentation and tracking logs
Support reduction of aging >90 days
Track denial resolution and appeal outcomes
Ensure payor enrollment status supports uninterrupted billing
Provide visibility into reimbursement risks and payer-related revenue impacts