AR Follow-up and Denial Specialist

Description

Title: AR Follow-up and Denial Specialist

Location: Onsite – Bethesda, MD (Hybrid)

Who We Are:

Aligned Orthopedic Partners is a well-respected private orthopedic team comprised of highly trained, board-certified orthopedic surgeons devoted to delivering patients with the highest orthopedic care possible. Our commitment to finding the best solutions for individual needs sets us apart from the competition. We take pride in providing exceptional care while remaining friendly, courteous, and efficient. 

Aligned Orthopedic Partners is recruiting an experienced AR Follow-up and Denial Specialist. The ideal candidate is experienced with analyzing and resolving insurance claim denials, correcting errors, and securing accurate reimbursement from payers. This role requires strong analytical, coding, and communication skills, with a focus on denial prevention, timely appeals, and collaboration across the revenue cycle team.

What You Will Do:

Claims Review & Correction

• Review denied and unpaid claims to verify coding and billing accuracy.
• Correct errors and submit revised claims when necessary.
• Investigate claims with no payer response to confirm receipt and follow up.

Denial Management & Appeals

• Analyze denials and generate effective, well-researched written appeals.
• Appeal denials through coding review, contract interpretation, medical record review, and direct payer interaction.
• Maintain detailed knowledge of payer websites and appeal processes for commercial and government payers.
• Ensure appeals and reconsideration requests are completed accurately and on time.

Trend Analysis & Communication

• Identify recurring denial trends or payer policy changes affecting reimbursement.
• Communicate trends to management and recommend process improvements to prevent reoccurrence.
• Support and participate in process and quality improvement initiatives.

Collaboration & Education

• Confer with coders, billing staff, and revenue cycle managers on coding or claim issues.
• Provide education to team members on payer policies and denial prevention.
• Collaborate on special projects and assist management with additional tasks as assigned.

Account Reconciliation

• Work assigned follow-up queues, including identification of missing payments, overpayments, and credits on accounts.
• Document all actions taken in the practice management system.

What you bring to the table:

You are a detail-oriented and dependable professional with a strong grasp of accounts receivable and denial processes. You take ownership of your work, communicate clearly, and consistently meet deadlines in a fast-paced environment. You bring: 

• Minimum of 3 years’ experience in a medical billing department (orthopedic or surgical experience strongly preferred).
• In-depth knowledge of healthcare billing, claims processing, payer follow-up, and appeals.
• Proficiency with payer websites, Microsoft Outlook, Word, and Excel.
• Coding knowledge sufficient to process denied claims and support appeals.
• Strong reasoning, critical thinking, analytical, and mathematical skills.
• Ability to work independently with high productivity and attention to detail.
• CPC certification preferred but not required.
• High School Diploma or GED required.

Equal Opportunity Employer

Aligned Orthopedic Partners is an equal opportunity employer. We promote diversity of thought, culture, and background. We celebrate what makes us different and committed to building a team that represents a variety of experiences. All employment is decided on the basis of qualifications, merit, and business need.