Surgical AR Representative

Spire Orthopedic Partners•Stamford, CT

3d•$24 - $36•Remote

About The Position

The Surgical AR & Denials Management Representative resolves complex accounts receivable and payer denials related to orthopedic and spine surgical services. The role requires advanced knowledge of surgical coding, payer reimbursement methodologies, bundling rules, medical necessity criteria, and appeals strategy. The representative manages high-dollar, complex surgical claims, pursues payer follow-up, drafts detailed appeals, and partners with coding and clinical teams to help prevent recurring denials. Experience with spine surgery reimbursement, including instrumented procedures and multi-level cases, is preferred. This is a performance-driven, detail-oriented role requiring strong analytical skills and the ability to independently resolve complex reimbursement issues. The position is full-time, day shift, and located in Stamford, Connecticut, with the job details identifying it as WFH. The role focuses on orthopedic and spine surgical claims and includes managing aging accounts, investigating denials, reviewing operative reports and payer contracts, pursuing underpayments, and maintaining compliant, timely account follow-up. Spire Orthopedic Partners is a growing national partnership of orthopedic practices. As a Management Services Organization, Spire provides administrative infrastructure, support, capital, and operational resources to its practices. The network is headquartered in Stamford, Connecticut, and spans the Northeast, with more than 165 physicians, 1,800 employees, 285 other clinical providers, and 40 locations in New York, Connecticut, Rhode Island, and Massachusetts.

Requirements

3–5+ years of AR follow-up and denial management experience in a physician practice or surgical specialty environment.
Demonstrated experience with orthopedic surgical claims.
Strong knowledge of CPT, ICD-10, HCPCS, NCCI edits, and modifier usage.
Experience with commercial, Medicare, and Workers’ Compensation payers.
Ability to analyze EOBs and payer remittance advice in detail.
Advanced surgical reimbursement knowledge.
Strong written appeal-drafting skills.
Analytical and problem-solving ability, persistence and follow-through, and attention to detail.
Ability to manage high-volume, high-dollar accounts.
Independent decision-making capability.
High school or equivalent education level.

Nice To Haves

Spine surgery reimbursement experience, including instrumented procedures and multi-level cases.
CPC certification (preferred but not required).

Responsibilities

Manage aging accounts receivable for orthopedic and spine surgical claims.
Perform detailed reviews of high-dollar surgical accounts.
Identify underpayments, bundling errors, and contractual discrepancies.
Escalate claims through payer reconsideration and appeals processes.
Follow up within payer filing limits and monitor timely filing and appeal deadlines.
Investigate and resolve denials involving medical necessity, bundling and NCCI edits, modifier denials, global period denials, downcoding, and prior authorization issues.
Draft comprehensive, evidence-based appeals with supporting documentation.
Track denial trends and escalate systemic issues to management.
Participate in payer peer-to-peer or escalation discussions as needed.
Understand reimbursement for complex orthopedic and spine procedures, including multi-level spinal fusions, instrumentation and hardware, decompression procedures, revision surgeries, and ASC versus hospital reimbursement differences.
Review operative reports to validate coding and appeal strategy.
Collaborate with the coding team on documentation improvement opportunities.
Review payer contracts to validate expected reimbursement.
Identify payment variances and contractual underpayments and assist in recovering underpaid claims.
Maintain detailed account notes documenting follow-up actions.
Ensure appeals and follow-up actions meet compliance standards and adhere to HIPAA and payer guidelines.