The Onyx Group - Denial & AR Follow-Up Specialist

Tribe513 | The Onyx Group•Greenville, SC

2d•Onsite

About The Position

The Denials & AR Follow-Up Specialist is responsible for the analysis, follow-up, and resolution of denied, underpaid, and unpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This role serves as a subject matter expert in payer reimbursement methodologies, denial management, appeals processing, and revenue recovery strategies. The Denials & AR Follow-Up Specialist performs complex account research, identifies root causes impacting reimbursement, prepares appeals, and collaborates with internal departments to resolve barriers to payment. This position plays a critical role in protecting organizational revenue through effective denial prevention, reimbursement recovery, and accounts receivable management.

Requirements

High School Diploma or equivalent required.
Minimum of 3–5 years of healthcare revenue cycle experience required.
Minimum of 2 years of direct experience in denials management, insurance follow-up, accounts receivable resolution, or reimbursement recovery required.
Advanced knowledge of healthcare reimbursement methodologies and insurance claims processing.
Strong understanding of denial management, appeals processes, and payer regulations.
Working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical necessity requirements.
Ability to interpret EOBs, ERAs, payer policies, and reimbursement guidelines.
Strong analytical and critical thinking skills.
Excellent problem-solving and root cause analysis abilities.
Strong organizational skills with the ability to manage a high-volume workload.
Effective written and verbal communication skills.

Nice To Haves

Associate's or Bachelor's degree preferred.
Experience working with physician practice billing, professional claims, and multi-specialty healthcare organizations preferred.
Certified Revenue Cycle Representative (CRCR) or willingness to obtain.
Epic
eClinicalWorks (eCW)
Waystar
FinThrive
Insurance payer portals
Microsoft Excel and reporting tools

Responsibilities

Review, analyze, and resolve denied claims across commercial, government, and managed care payers.
Identify denial root causes including coding, authorization, eligibility, credentialing, registration, documentation, and payer processing issues.
Prepare and submit first-level, second-level, and complex appeals within payer filing deadlines.
Obtain and review medical records, referrals, authorizations, operative reports, and supporting documentation necessary for appeal submissions.
Monitor appeal status and perform ongoing follow-up until final claim resolution.
Escalate payer trends and unresolved denial issues as appropriate.
Maintain an assigned inventory of accounts receivable and work accounts according to departmental productivity and aging standards.
Perform comprehensive account research to identify barriers preventing reimbursement.
Contact insurance carriers through payer portals, correspondence, and direct communication to resolve outstanding balances.
Pursue payment on denied, partially paid, and unpaid claims.
Identify and resolve reimbursement discrepancies, payment variances, and payer processing errors.
Ensure all follow-up activities are documented accurately and timely within the billing system.
Analyze Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer correspondence, and contractual reimbursement expectations.
Investigate underpayments and payment variances to ensure accurate reimbursement.
Review payer guidelines, contracts, and policies to support reimbursement recovery efforts.
Recommend corrective actions to improve reimbursement outcomes and reduce future denials.
Identify opportunities for revenue recovery and process improvement.
Identify recurring denial trends and reimbursement obstacles.
Partner with Coding, Credentialing, Registration, Authorizations, Cash Posting, Credits, and Billing teams to resolve systemic issues.
Provide feedback regarding operational, workflow, or system issues contributing to denials.
Participate in denial prevention initiatives and revenue cycle improvement projects.
Assist leadership in identifying opportunities to improve clean claim rates and reduce accounts receivable aging.
Utilize Epic and/or eClinicalWorks (eCW) to review claim activity, account history, and reimbursement information.
Utilize Waystar, FinThrive, payer portals, and other revenue cycle technologies to research and resolve claims.
Maintain accurate and complete account documentation supporting all actions taken.
Ensure account notes support audit readiness and operational transparency.
Maintain compliance with CMS regulations, payer requirements, HIPAA standards, and organizational policies.
Ensure appeals and follow-up activities meet payer filing deadlines.
Maintain high levels of accuracy, quality, and productivity.
Support internal and external audit requests as needed.