POSITION SUMMARY

The Denials/AR Specialist is responsible for managing all denied and outstanding claims for AlphaCare Urgent Care, working every denial to resolution through correction, resubmission, or appeal to protect the organization's revenue cycle.

ABOUT ALPHACARE URGENT CARE

AlphaCare Urgent Care is a multi-location urgent care provider dedicated to delivering compassionate, high-quality healthcare to communities across the Gulf Coast, with seven convenient locations in Mississippi and Alabama open seven days a week from 8:00 a.m. to 8:00 p.m. Driven by a mission to make excellent healthcare accessible and affordable, AlphaCare connects patients with highly trained providers who specialize in the management of urgent and emergent conditions, offering a faster and more cost-effective alternative to the emergency room. Guided by core values of excellence, service, integrity, accountability, unity, and adaptability, AlphaCare is committed to changing the way healthcare is delivered on the Coast, one patient at a time.

SUCCESS LOOKS LIKE

All denied claims are worked within 48 hours of receipt and no denial ages past the payer's appeal deadline without a filed appeal or documented write-off decision Denial overturn rate trends upward month over month as appeal quality improves and root cause patterns are identified and corrected at the claims level Days in AR stays within benchmark and no payer bucket exceeds 90 days without escalation to the Billing Manager

OBJECTIVES

Review all denied and rejected claims daily and work each denial within 48 hours of receipt, determining the appropriate resolution path: correction and resubmission, formal appeal, or documented write-off File appeals for all clinically and contractually disputable denials within payer-required timelines, attaching all supporting documentation including medical records, clinical notes, coding rationale, and payer contract language as applicable Identify denial patterns by payer, denial reason code, and provider or clinic location and report recurring root causes to the Billing Manager weekly with recommendations for upstream correction Manage the AR aging report daily, prioritizing claims by payer deadline, dollar amount, and denial reason to ensure high-value and time-sensitive accounts are worked first Contact payers via phone, portal, or written correspondence to obtain status updates on pending claims, escalate stalled appeals, and resolve claim-level issues that cannot be corrected through resubmission alone Coordinate with the Claims/Coding team to provide denial context and request corrected claims or additional documentation needed for appeal Track all denial and appeal activity in the practice management system with accurate status codes, follow-up dates, and resolution notes so the AR record reflects the current state of every account Monitor payer-specific denial trends, policy updates, and claims editing rules that contribute to recurring denial reasons and communicate changes to the Billing Manager for team-wide correction Participate in monthly AR reviews with the Billing Manager, presenting denial volume, overturn rate, AR aging status, and outstanding payer escalations Complete all required training on Athenahealth or applicable billing software updates, payer portal navigation, and appeal best practices as assigned Maintain strict compliance with HIPAA and payer-specific requirements for all claim correspondence, documentation requests, and appeal submissions Operate in full alignment with AlphaCare's core values in every payer interaction, team collaboration, and revenue protection decision

COMPETENCIES

Treats every denial as a recoverable revenue opportunity until the payer deadline has passed or a write-off has been documented and approved Reads and interprets EOBs, ERAs, and denial reason codes accurately, knowing which denials require a corrected claim versus a formal appeal versus a provider authorization escalation Manages a high-volume AR queue with daily prioritization discipline, ensuring no claim ages into a write-off due to missed deadlines or inattention Writes clear, evidence-based appeal letters that cite the clinical record, CPT/ICD-10 documentation, and specific payer contract language in a way that maximizes overturn likelihood Identifies root cause denial patterns and communicates them clearly to the Billing Manager and Claims team, understanding that fixing the upstream issue is more valuable than winning a single appeal Follows up on payers consistently and persistently, using portal status checks, call logs, and escalation paths to move stalled claims without waiting for the payer to act Maintains detailed and current AR notes so any team member can pick up an account and understand its full status and history without asking Handles all patient and payer data with strict confidentiality and HIPAA compliance at all times

EDUCATION AND EXPERIENCE

High school diploma or GED required; associate's degree in health information management, business, or a related field preferred 1 or more years of medical billing experience with a focus on denial management, AR follow-up, or payer appeals in an outpatient or physician office setting Working knowledge of denial reason codes, EOB/ERA interpretation, CMS-1500 claim form, and payer appeals processes for commercial, Medicare, and Medicaid payers Experience with Athenahealth or a comparable practice management system preferred; CPC, CPMA, or equivalent medical billing certification preferred

PHYSICAL REQUIREMENTS

Office-based role with the ability to sit and work at a computer for extended periods throughout the workday Ability to manage multiple payer portals, billing software screens, and documentation sources simultaneously Ability to lift and transport files or office supplies up to 25 lbs as needed

COMMITMENT TO DIVERSITY

As an equal opportunity employer committed to meeting the needs of a multigenerational and multicultural workforce, AlphaCare Urgent Care recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation or disability, and actively foster inclusion in all forms both within our company and across interactions with clients, candidates and partners. If this position caught your eye, send us your resume! For best consideration, include the job title and source where you found this position in the subject line of your email to adminassistant@alphacareurgentcare.com. Already an AlphaCare Urgent Care candidate? Please connect directly with your recruiter to discuss this opportunity.

Pay:

$17.00 - $18.00 per hour Expected hours: 8.0 per week

Benefits:

401(k) Dental insurance Health insurance Health savings account Paid time off Vision insurance

Work Location:

In person