Insurance Denials Specialist (AR)
About The Position
INSURANCE DENIALS SPECIALIST Maximize Reimbursements Through Strategic Problem-Solving Location: AICA Orthopedics Headquarters - Marietta, GA Position Impact The Insurance Recovery Specialist plays a critical role in AICA Orthopedics' financial performance by systematically securing appropriate reimbursements across our 21 locations. This position requires methodical analysis, technical expertise, and persistent follow-up to ensure claims are processed correctly and paid in full. Your ability to navigate complex payer requirements, identify root causes of denials, and implement precise resolution strategies directly impacts the organization's revenue capture.
Requirements
- 2+ years experience in medical billing, insurance collections, or revenue cycle
- Demonstrated success in denial management and claim resolution
- Strong understanding of insurance reimbursement processes and medical coding
- Excellent analytical and problem-solving abilities
- Methodical approach to documentation and follow-up
- Proficiency with NextGen, Salesforce, or similar healthcare/CRM systems
- Attention to detail and commitment to accuracy
- In-Office - Marietta, GA
Nice To Haves
- Experience with orthopedic, neurology, or physical therapy billing
- Knowledge of personal injury cases and related insurance processes
- Certification in medical billing or revenue cycle management (CPC, CPMA, etc.)
- Background in healthcare administration or finance
Responsibilities
- Analyze denied claims to identify specific reasons for rejection and determine optimal resolution paths
- Apply in-depth knowledge of payer policies, medical coding, and documentation requirements to craft effective appeals
- Implement systematic follow-up protocols based on payer-specific timelines and requirements
- Document all actions, communications, and resolution steps with meticulous attention to detail
- Track denial patterns to help identify and address systemic issues
- Verify insurance benefits and secure necessary pre-authorizations to prevent future denials
- Review and correct claim errors prior to submission when possible
- Ensure all supporting documentation meets payer requirements for efficient processing
- Reconcile payments against fee schedules to identify and address underpayments
- Coordinate with clinical teams to obtain required documentation for successful appeals
- Research complex claim issues using multiple information systems and payer portals
- Apply detailed understanding of medical terminology and procedural requirements
- Implement systematic approaches to resolve similar denials efficiently
- Maintain current knowledge of changing payer policies and requirements
- Apply critical thinking to develop solutions for unusual or complex reimbursement challenges
Benefits
- Competitive hourly rate with potential for performance-based incentives
- Clear path for advancement to Senior Specialist, Team Lead, or Management roles
- Comprehensive benefits including medical, dental, vision, and 401(k)
- Professional development and specialized certification opportunities
- Ability to contribute directly to the financial health of a growing healthcare organization
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
