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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.