Job Title:
Denials & AR Follow-Up Specialist Weekly Hours:
40 hours per week, Schedule Options (Onsite): Monday
- Friday, 8:00 AM
- 5:00 PM (1-hour lunch) or Monday
- Friday, 8:00 AM
- 4:30 PM (30-minute lunch) Supervised by: Denials & AR Follow-Up Team Lead /
Revenue Cycle Manager Position Overview:
The Denials & AR Follow-Up Specialist is responsible for the analysis, follow-up, and resolution of denied, underpaid, and unpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This role serves as a subject matter expert in payer reimbursement methodologies, denial management, appeals processing, and revenue recovery strategies. The Denials & AR Follow-Up Specialist performs complex account research, identifies root causes impacting reimbursement, prepares appeals, and collaborates with internal departments to resolve barriers to payment. This position plays a critical role in protecting organizational revenue through effective denial prevention, reimbursement recovery, and accounts receivable management.
Responsibilities:
Denials Management Review, analyze, and resolve denied claims across commercial, government, and managed care payers. Identify denial root causes including coding, authorization, eligibility, credentialing, registration, documentation, and payer processing issues. Prepare and submit first-level, second-level, and complex appeals within payer filing deadlines. Obtain and review medical records, referrals, authorizations, operative reports, and supporting documentation necessary for appeal submissions. Monitor appeal status and perform ongoing follow-up until final claim resolution. Escalate payer trends and unresolved denial issues as appropriate. Accounts Receivable Follow-Up Maintain an assigned inventory of accounts receivable and work accounts according to departmental productivity and aging standards. Perform comprehensive account research to identify barriers preventing reimbursement. Contact insurance carriers through payer portals, correspondence, and direct communication to resolve outstanding balances. Pursue payment on denied, partially paid, and unpaid claims. Identify and resolve reimbursement discrepancies, payment variances, and payer processing errors. Ensure all follow-up activities are documented accurately and timely within the billing system. Revenue Recovery & Reimbursement Analysis Analyze Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer correspondence, and contractual reimbursement expectations. Investigate underpayments and payment variances to ensure accurate reimbursement. Review payer guidelines, contracts, and policies to support reimbursement recovery efforts. Recommend corrective actions to improve reimbursement outcomes and reduce future denials. Identify opportunities for revenue recovery and process improvement. Root Cause Analysis & Denial Prevention Identify recurring denial trends and reimbursement obstacles. Partner with Coding, Credentialing, Registration, Authorizations, Cash Posting, Credits, and Billing teams to resolve systemic issues. Provide feedback regarding operational, workflow, or system issues contributing to denials. Participate in denial prevention initiatives and revenue cycle improvement projects. Assist leadership in identifying opportunities to improve clean claim rates and reduce accounts receivable aging. System Utilization & Documentation Utilize Epic and/or eClinicalWorks (eCW) to review claim activity, account history, and reimbursement information. Utilize Waystar, FinThrive, payer portals, and other revenue cycle technologies to research and resolve claims. Maintain accurate and complete account documentation supporting all actions taken. Ensure account notes support audit readiness and operational transparency. Compliance & Quality Maintain compliance with CMS regulations, payer requirements, HIPAA standards, and organizational policies. Ensure appeals and follow-up activities meet payer filing deadlines. Maintain high levels of accuracy, quality, and productivity. Support internal and external audit requests as needed. Key Outcomes / Performance Expectations Reduction in aged accounts receivable inventory. Increased denial overturn and appeal success rates. Timely resolution of denied, underpaid, and unpaid claims. Recovery of reimbursement that may otherwise be written off. Accurate account documentation and claim follow-up activities. Identification and communication of denial trends and systemic reimbursement issues. Achievement of productivity, quality, and aging performance goals.
Required Education & Certifications:
High School Diploma or equivalent required. Associate's or Bachelor's degree preferred. Minimum of 3-5 years of healthcare revenue cycle experience required. Minimum of 2 years of direct experience in denials management, insurance follow-up, accounts receivable resolution, or reimbursement recovery required. Experience working with physician practice billing, professional claims, and multi-specialty healthcare organizations preferred. Knowledge & Skills Advanced knowledge of healthcare reimbursement methodologies and insurance claims processing. Strong understanding of denial management, appeals processes, and payer regulations. Working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical necessity requirements. Ability to interpret EOBs, ERAs, payer policies, and reimbursement guidelines. Strong analytical and critical thinking skills. Excellent problem-solving and root cause analysis abilities. Strong organizational skills with the ability to manage a high-volume workload. Effective written and verbal communication skills.
Systems Experience Preferred experience with:
Epic eClinicalWorks (eCW) Waystar FinThrive Insurance payer portals Microsoft Excel and reporting tools Certifications Certified Revenue Cycle Representative (CRCR) or willingness to obtain. Success Metrics Accounts receivable dollars resolved. Denial overturn percentage. Appeal success rate. Reduction in AR aging. Reimbursement dollars recovered. Productivity and quality scores. Compliance with payer filing deadlines. Accuracy and completeness of account documentation.
Physical Demands:
Continuously requires sitting, typing, verbal communication. Frequently requires reaching outward, reaching above the shoulder, lifting items weighing 10 pounds or less, pushing/pulling items weighing 10 pounds or less. Infrequently requires pushing/pulling items weighing up to 50 pounds, pushing/pulling items weighing above 50 pounds, lifting items weighing up to 50 pounds, lifting items weighing up to 20 pounds, squatting/kneeling, bending, crawling. bending, and climbing.
Work Environment:
Person may be exposed to fumes, airborne particles, infectious diseases, blood/bodily fluids, and disease-bearing specimens. The Onyx Group is an Equal Opportunity Employer.
