Position Overview:

The AR Follow-up & Denial Management Specialist is responsible for the timely resolution of unpaid, underpaid, and denied medical claims to maximize reimbursement and reduce accounts receivable (AR) aging. This role analyzes denials, identifies root causes, and drives corrective actions including claim resubmissions, appeals, and payer follow-up. The position partners cross-functionally with billing, coding, authorization, and vendor teams to resolve issues impacting reimbursement and overall revenue cycle performance. In addition to transactional responsibilities, this role supports trend analysis, workflow optimization, and performance improvement initiatives. Success in this role requires strong analytical skills, payer knowledge, and the ability to manage high-volume workloads while maintaining accuracy and compliance. Performs other duties as assigned.

Job Roles & Responsibilities:

Follow up on unpaid, underpaid, and denied claims across commercial, Medicare, and Medicaid payers

Review Explanation of Benefits (EOB/ERA) to validate denial and underpayment reasons
Analyze denial trends, identify root causes, and implement corrective actions
Correct claims and submit resubmissions, reconsiderations, and appeals based on payer requirements and contract terms
Generate and track appeals, ensuring appropriate documentation and adherence to payer guidelines
Communicate with payers and internal teams (coding, billing, prior authorization) to resolve claim issues
Maintain accurate and detailed documentation of all follow-up activities in compliance with HIPAA and payer requirements
Escalate payment variances, trends, and systemic issues to leadership
Track outcomes of claims, appeals, and payment resolutions to ensure performance goals are met
Utilize job aids, SOPs, and payer guidelines to ensure consistent and accurate processing
Support development and improvement of workflows, processes, and tracking mechanisms
Participate in weekly/monthly performance reviews, reporting on trends, risks, and opportunities
Collaborate with cross-functional teams and vendor partners to improve reimbursement outcomes
Serve as a subject matter resource for denial management processes and payer requirements
Stay current on billing, coding, and payer policy changes impacting revenue cycle performance

Qualifications & Requirements:

Experience & Education 3+ years of experience in medical billing, AR follow-up, or denial management within U.S. healthcare

Experience with prior authorization, payer utilization management policies, and appeals preferred
Healthcare-related degree or equivalent experience Skills & Competencies
Strong analytical and problem-solving skills with a focus on root cause identification
Ability to identify trends, develop insights, and communicate findings clearly
Excellent verbal and written communication skills
Strong organizational and time management skills with the ability to manage multiple priorities
Ability to work independently and collaboratively in a fast-paced environment
Strong attention to detail and commitment to accuracy
Ability to think critically and understand downstream revenue cycle impact
Maintains strict confidentiality of sensitive patient and financial information Performance Expectations
Consistently meet or exceed productivity and quality benchmarks
Drive timely resolution of claims to improve cash flow and reduce AR aging Credence Resource Management v2.0 Effective - April 8, 2026
Proactively identify and escalate trends impacting reimbursement
Ensure compliance with payer guidelines and regulatory requirements
Contribute to continuous improvement initiatives and workflow optimization Key KPI's AR days reduction
Denial overturn rate
First-pass resolution rate
Net collection rate
Productivity and quality scores

Pay:

$20.00 - $22.00 per hour

Benefits:

401(k) Life insurance Paid time off

Work Location:

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