denial management specialist

Jordan Young Institute

<div>Title: AR Follow-up and Denial Specialist
Location: Onsite &ndash; Virginia Beach, VA (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 &amp; Correction<ul><li>
Review denied and unpaid claims to verify coding and billing accuracy.</li><li>
Correct errors and submit revised claims when necessary.</li><li>
Investigate claims with no payer response to confirm receipt and follow up.</li></ul>
Denial Management &amp; Appeals<ul><li>
Analyze denials and generate effective, well-researched written appeals.</li><li>
Appeal denials through coding review, contract interpretation, medical record review, and direct payer interaction.</li><li>
Maintain detailed knowledge of payer websites and appeal processes for commercial and government payers.</li><li>
Ensure appeals and reconsideration requests are completed accurately and on time.</li></ul>
Trend Analysis &amp; Communication<ul><li>
Identify recurring denial trends or payer policy changes affecting reimbursement.</li><li>
Communicate trends to management and recommend process improvements to prevent reoccurrence.</li><li>
Support and participate in process and quality improvement initiatives.</li></ul>
Collaboration &amp; Education<ul><li>
Confer with coders, billing staff, and revenue cycle managers on coding or claim issues.</li><li>
Provide education to team members on payer policies and denial prevention.</li><li>
Collaborate on special projects and assist management with additional tasks as assigned.</li></ul>
Account Reconciliation<ul><li>
Work assigned follow-up queues, including identification of missing payments, overpayments, and credits on accounts.</li><li>
Document all actions taken in the practice management system.</li></ul>
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:<ul><li>
Minimum of 3 years&rsquo; experience in a medical billing department (orthopedic or surgical experience strongly preferred).</li><li>
In-depth knowledge of healthcare billing, claims processing, payer follow-up, and appeals.</li><li>
Proficiency with payer websites, Microsoft Outlook, Word, and Excel.</li><li>
Coding knowledge sufficient to process denied claims and support appeals.</li><li>
Strong reasoning, critical thinking, analytical, and mathematical skills.</li><li>
Ability to work independently with high productivity and attention to detail.</li><li>
CPC certification preferred but not required.</li><li>
High School Diploma or GED required.</li></ul>
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.</div>

AR Follow-up and Denial Specialist

Macrise Tech Solutions

Accounts Receivable &amp; Denial Management<ul><li>Oversee and manage outstanding insurance claims to help reduce overall Accounts Receivable (AR) balances.</li><li>Perform routine follow-ups on denied claims to ensure timely resolution and optimize recovery outcomes.</li><li>Review Electronic Remittance Advice (ERA) reports to identify recurring denial trends and recommend preventive and corrective actions.</li><li>Prepare, submit, and track appeals for denied or underpaid claims, ensuring all supporting documentation is complete and accurate.</li><li>Investigate payment discrepancies and escalate complex or unresolved issues to the Billing Manager when necessary.</li><li>Maintain accurate and up-to-date AR aging reports, providing regular weekly and monthly performance updates.</li><li>Manage billing and claims for specialized services, including TMS, Spravato, and psychological assessments.</li><li>Partner with the Billing Manager to achieve AR reduction, recovery, and accuracy goals.</li></ul>Patient &amp; Provider Communication<ul><li>Respond promptly and professionally to billing-related inquiries from patients, providers, and internal stakeholders.</li><li>Review and verify patient account information before initiating collections or claim follow-ups.</li><li>Collaborate with providers to resolve claim issues, including coding errors and missing documentation.</li><li>Communicate with insurance payers regarding eligibility, prior authorizations, and network participation.</li><li>Address patient concerns with professionalism and empathy, including processing refunds when applicable.</li></ul>Systems Management &amp; Process Improvement<ul><li>Create, monitor, and resolve billing-related support tickets within the eClinicalWorks (eCW) system.</li><li>Provide guidance and support to team members on AR follow-up strategies and denial resolution workflows.</li><li>Coordinate with U.S.-based billing teams to ensure accurate and timely claim submissions.</li><li>Participate in operational meetings to review performance metrics, analyze trends, and recommend process improvements.</li><li>Stay up to date with payer policies, regulatory requirements, and industry best practices in medical billing and reimbursement.</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English? (Required)</li></ul>Work Location: In person

Medical Billing & AR Specialist

Huntsville Hospital Health System

<div>Overview:
<div>
Reviews and audits accounts located in contract management system on a daily basis to resolve and maintain collection status on an account prior to escalating to Team Lead for further review. Reviews and processes non-governmental accounts through contract management system. Verifies eligibility, corrects and resubmits claim, and files third party insurances as necessary by adding/updating insurance information to host system. Utilizes denial management system and responds to requests from insurance carrier for additional information necessary to process claims. Analyzes expected reimbursement information in contract management system. Utilizes the system/contract foundation to ensure the accounts are properly paid. Reviews EOB's in contract management system and determines accurate account balance, detailed denial description, and applicable appeal process. Identifies and corrects transactions, such as invalid insurance information, incorrect charges, and posting errors, in host system. Posts adjustments in host system. Reviews and verifies claim export data in electronic billing, contract management and/or host systems.</div>
Qualifications:
<div>
Minimum Knowledge, Skills and Experience required: 
Education: High school diploma or GED.
 
Experience: 6 months to 1 year working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred. 
Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred. 
Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred. 
Additional Skills: General application knowledge of EXCEL and WORD. 
Effective communication skills verbally and written with internal Hospital departments, Physician Offices, Patient, and Insurance payors.
 
Must be able to effectively manage a large volume of accounts while maintaining a high accuracy and positive outcomes.</div>
About Us:

Highlights of our hospitals
Huntsville Hospital was recently named Best Regional Hospital and #2 in Alabama by U.S. News &amp; World Report. With 971 beds, a specialized Orthopedic &amp; Spine Tower, a Level III Regional Neonatal ICU, and the largest Emergency Department and Level 1 Trauma Center in the state with our own specialized Red Shirt Trauma Program, there are many opportunities to apply your knowledge and skills. We are a certified Primary Stroke Center and named &quot;One of the Top 100 Hospitals in the Nation with Great Heart Programs.&quot; From six cath labs and four EP labs to multiple medical and step-down units, you can continually grow your skillset! We offer a training center on campus for continuing education, Shared Governance Program, Clinical Ladder for professional development, The Daisy Award, and if you are a new grad, a Nurse Residency Program to help you transition from student to professional nurse. We care about you and your well-being by offering an excellent benefits package, childcare, health and wellness programs, an onsite employee pharmacy, a free health clinic, tuition assistance, and much more. We are committed to creating a diverse environment and proud to be an equal opportunity employer. We are a partner to the U.S. Army&rsquo;s Partnership for Your Success (PaYS) program. 
Ask us about incentives and additional opportunities. 
Huntsville Hospital Benefits:
We are committed to providing competitive benefits. Our benefits package for eligible employees includes medical, dental, vision, life insurance, flexible spending; short term and long term disability; several retirement account options with 401K organization match; nurse residency program; tuition assistance; student loan reimbursement; On-site training and education opportunities; Employee Discounts to phone providers, local restaurants, tickets to shows, apartment application and much more! 
 Learn more about Huntsville Hospital Health System:<ul><li>
Careers: https://careers.hhsys.org/careers-home</li><li>
Benefits: https://careers.hhsys.org/us/en/benefits</li><li>
Education &amp; Professional Development: https://www.huntsvillehospital.org/education</li><li>
Life In Huntsville: https://www.huntsvillehospital.org/about-huntsville-al</li></ul></div>

Collector 2- CBO2

Hard stone enterprises

<ul><li>The Candidate must have 6 months to 2 years of experience. </li><li>Should have the ability to plan the AR and steer it up effectively.</li><li>Must know about Denial Management, Appeals, and Payment posting.</li><li>Can analyse ERAs &amp; EOBs and, when possible, suggest potential remedies.</li><li>Good verbal and written English communication skills.</li><li>May communicate with the insurance and other parties involved in the RCM.</li></ul>Job Type: Full-timePay: Rs75,000.00 - Rs90,000.00 per monthAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Work Location: In person

AR Specialist (Medical Billing)

Wellstar Health System

<div>How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
Day (United States of America)<h2 class="jobSectionHeader">
Job Summary:</h2>
Under the direction of the Manager of Account Resolution, the Account Resolution Representative II assists with planning and coordinating HB Accounts Resolution follow up activities for an account receivable portfolio of ~ approximately $375M-$500M, including, but not limited to collaboratively working with their Team Lead, Manager, and assisting with training, employees, as circumstances dictate. The Account Resolution Representative II will assist with the development of strategies for establishing a continuous improvement work environment, ensure eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer time frames and are documented appropriately in the patient accounting system. As well as providing educational support in a variety of departmental and individual settings. The role requires data analysis, trending analysis, and educational capabilities regarding payor and revenue cycle business related processes. This role requires a versatile and well developed actionable understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation and provider / payor appeal requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable trending and findings is needed. The core role focus of this position is to ensure that accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Account Resolution Representative II must possess the ability to assist with developing and documenting action plans for quick resource deployment, communicate timely with leadership to understand the specific reasons for payment delays. The role requires the ability to effectively and efficiently communicate both orally and in writing to leadership, multi-task, meet deadlines, adhere to organizational policies and procedures. In addition, the Account Resolution Representative II will assist with additional Revenue Cycle related tasks and duties as assigned.
<h2 class="jobSectionHeader">Core Responsibilities and Essential Functions:</h2>
Maintain a working knowledge and perform assigned duties in compliance of all-departmental billing and follow-up policies, procedures, processes and functions. Respond appropriately to inquiries from 3rd parties, insurance providers and patients regarding accounts, collection issues and hospital policies, to insure a minimal Accounts Receivables inventory. * Collect and resolve payments from insurance companies by working with assigned payers and utilizing established policies and procedures. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Successfully appeal denied accounts and avoid excessive deferred accounts * Demonstrate effective collaboration skills, and support to the follow-Up staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of workflow, as instructed by leadership. Review account receivables while evaluating trends and tracking recovery efforts by utilizing various departmental tools optimizing individual workflow and process to reduce AR growth, quickly propose solutions to reduce trends, resolve issues, etc. Consistently meet the productivity and quality standards. * Assist staff by providing direction and guidance, creating a team environment through training, recognition, and education which produces optimum work habits and job performance * Assist with setting obtainable short-term goals, maintaining expected level of productivity and quality as defined by policy, or equivalent industry standards when not specifically defined by policy, as well as assisting with performance studies to improve productivity, streamline operations and reduce error rates. Provide assistance with staff training and oversight to ensure that implemented policies and procedures are being followed. Meet deadlines established through interaction with the Manager of Accounts Resolution or other senior leadership. * Review and improve work procedures to ensure that the most productive and efficient methods are used * Monitor progress for assigned workflow on a daily basis, utilizing quantitative technology and tools and providing feedback to leadership regarding success and obstacles to claim resolution * Provide assistance with departmental projects and presentations, as needed. * Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership. * Resolve complaints and misunderstandings in a timely and appropriate manner while demonstrating the ability to tactfully handle difficult situations through an approach that reflects consistency and fairness. * Must maintain a proficiency in the application of, key automated systems that include: Epic, Emdeon Claims Master. * Act as an internal resource; resolving problems and providing expertise to other hospital departments * Review write-off requests, miscellaneous cash adjustments, and submit to manager for approval * Maintain Epic assigned workqueues to ensure timely (7 days or as specified) resolution of review requests. Become cross-trained and fill in for other staff as assigned. * Maintain a working knowledge of WellStar policies and procedures * Maintain membership and active participation in the HFMA professional organization or equivalent, to participate in workshops and classes ensuring a competency level beneficial to the department, as well as to meet minimum requirements in technology advances/applications. * Administrative * Maintain professional relations and convey relevant information to other members of the team within the facility and any applicable vendors Must actively participate and support the efforts of the Revenue Cycle Task Force, Monthly Denials Task Force, Monthly Compliance Coding Partnership as well as other committees as assigned. * Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Manager of Accounts Resolution aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public. * Assist with reviewing denial reports and determining significant problems causing rejections and denials; communicate with the leadership of Accounts Resolution the findings and proposes denial prevention solutions * Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt &amp; Collection Act guidelines, Medicare &amp; Medicaid regulations and reimbursement methodology, as well as state and federal laws. * Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities. * Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts. Assist with the development, processes and efficiency of Insurance Follow-Up and Denial policies &amp; procedures to ensure they are comprehensive in nature and current/updated. * Consistent review of current processes to ensure compliance with policies and procedures. * Assist with establishing controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly * Ensure optimal system capabilities by assisting with staff training, documenting system parameters, challenging systems and obtaining feedback from staff/users. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.
<h2 class="jobSectionHeader">Required Minimum Education:</h2><ul><li>
High School Diploma General or GED General</li></ul>
<h2 class="jobSectionHeader">Required Minimum License(s) and Certification(s):</h2>
All certifications are required upon hire unless otherwise stated.
<h2 class="jobSectionHeader">Additional License(s) and Certification(s):</h2>
Certified Revenue Cycle Representative within 180 Days Preferred
<h2 class="jobSectionHeader">Required Minimum Experience:</h2>
Minimum 1 year Experience as an Account Follow-up Representative I or a minimum of two (2) years in hospital patient financial services or related area Required and Must have a thorough understanding of Governmental, i.e. Medicare, Medicaid and / or Non-Governmental, i.e. Commercial: healthcare revenue cycle functions, PFS operations, regulations and reimbursement methodology, denials management, payor technical denial appeals and a proven track record of successful performance within the Revenue Cycle Required
<h2 class="jobSectionHeader">Required Minimum Skills:</h2>
Strong interpersonal, mathematical, analytical, computer, problem solving and writing skills, with a take charge attitude. Must be comfortable interacting with insurance providers, physicians and leadership. . Must be able to perform a wide variety of tasks that require independent judgment, ingenuity, and initiative. Competent with MS Word, PowerPoint, and MS Excel is required as critical analysis will be conducted using this technology. Ability to: establish a climate to achieve optimal performance levels and maintain a cohesive work team work efficiently under pressure and deal effectively with constant change operate a computer and related applications apply appropriate supervisory, management and leadership techniques in an operational setting work independently and take initiative demonstrate a commitment to continuous learning deal effectively with difficult people and/or difficult situation willingly accept responsibility and/or delegate responsibility set priorities and use good judgment for self and staff
Join us and discover the support to do more meaningful work&mdash;and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.</div>

Acct Resolution Rep II

HiredFirst

<div>Billing Follow Up Associate - REMOTE<ul><li>
Duration: 13 weeks</li><li>
Shift Details: REMOTE: Day Shift, 8 hrs day, 40 hours week, M-F 8am-4:30pm. Prefer candidates with Rev Cycle Experience (billing, claim, follow-up, denial competency)</li><li>
Shift Type: 1st 8h</li><li>
Location: Roseville, CA</li><li>
Unit: RC PFS - Portland General</li><li>
Specialty: Emergency Room (ER)</li><li>
Local Pay: $20.38/hr</li><li>
Estimated Weekly Travel Pay: $875/week</li><li>Note: Travel per diems will follow GSA guidelines to ensure compliance.</li></ul>
Please apply today to discuss further!
HFFC 14704
#Workwolf</div>

Billing Follow Up Associate - REMOTE

Top Line Resource Group (TLRG)

Location: DHA Phase 8, Lahore [Onsite]Employment Type: Full-timeWork Timing: 05PM &ndash; 02AM Pakistan TimeJob OverviewTopline Resource Group (TLRG) is seeking a highly experienced and results-driven Revenue Cycle Management (RCM) Specialist to oversee operations for multiple healthcare clients across different states.The ideal candidate will have extensive experience managing the end-to-end medical billing revenue cycle, including insurance verification, coding review, claims submission, payment posting, accounts receivable follow-ups, and denial management.Key ResponsibilitiesOversee and manage end-to-end Revenue Cycle Management operations for multiple healthcare provider clients.Supervise and support internal RCM teams handling:<ul><li>Insurance Verification (VOBs)</li><li>Prior Authorizations</li><li>Medical Coding Review</li><li>Charge Entry</li><li>Claims Submission</li><li>Payment Posting</li><li>Accounts Receivable (AR) Follow-ups</li><li>Denial Management</li></ul>Monitor claim lifecycle performance, ensuring accurate and timely claim submissions and reimbursements.Analyze EOBs, ERAs, and payer remittance reports to identify trends in denials, underpayments, and claim rejections.Communicate directly with US insurance payers and client representatives to resolve complex billing issues.Ensure compliance with payer policies, CMS regulations, and HIPAA guidelines.Develop and implement process improvements to increase collection rates and reduce AR aging.Track and manage KPIs including AR aging, denial rate, clean claim rate, and reimbursement turnaround time.Provide training, mentorship, and performance management for RCM staff.Coordinate with internal departments including coding, billing, compliance, and client services to ensure seamless revenue cycle operations.Maintain accurate documentation and reporting for client performance metrics and operational updates.Required Qualifications<ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business, or a related field preferred.</li><li>5+ years of experience in Medical Billing and Revenue Cycle Management.</li><li>Minimum 2 years of experience in a supervisory or team lead role within an RCM environment.</li><li>Strong knowledge of the complete medical billing lifecycle.</li></ul>Expert-level familiarity with:<ul><li>CPT Codes</li><li>ICD-10 Codes</li><li>HCPCS Codes</li><li>Claim submission workflows</li><li>Denial management processes</li></ul>Experience working with multiple payers including Medicare, Medicaid, and Commercial insurance plans.Hands-on experience with EHR/EMR and Practice Management systems.Strong analytical and problem-solving abilities for resolving complex claim and reimbursement issues.Excellent verbal and written English communication skills for interacting with US clients and payers.Ability to manage high-volume workloads while maintaining accuracy and compliance.Preferred SkillsPrior experience managing multiple US healthcare provider accounts across different states.Experience working in US healthcare BPO or medical outsourcing environments.Familiarity with payer-specific billing guidelines and state-based insurance requirements.Strong leadership skills with the ability to build and manage high-performing RCM teams.Experience with performance reporting, operational dashboards, and AR analytics.Knowledge of HIPAA compliance, CMS regulations, and payer audit requirements.Application Question(s):<ul><li>We are looking to hire immediately, are you available to join immediately?</li></ul>Experience:<ul><li>RCM: 4 years (Required)</li></ul>Work Location: In person

Revenue Cycle Management (RCM) Manager

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