Insurance Revenue Specialist - Hybrid Job Pine Bluff area,Arkansas USA,Healthcare

KICK
for theG
OAL

Ortho Arkansas' core values

K
INDNESS

People are happier after interactions with you because you are kind and pleasant.

I
NTEGRITY

Always doing the right thing, especially when no one is looking.

C
ONSCIENTIOUSNESS

Strive for excellence in all that you do, paying special attention to the details that make a difference in patient care and teamwork.

K
NOWLEDGE

Be a lifelong learner.

Position Overview:

The Revenue Appeals and Denials Specialist at Ortho Arkansas plays a critical role in protecting and maximizing reimbursement by resolving denied, underpaid, and outstanding insurance claims. This position is responsible for investigating claim denials, preparing appeals, recovering lost revenue, and identifying reimbursement trends that impact organizational performance. The ideal candidate possesses strong analytical skills, a thorough understanding of insurance reimbursement methodologies, and experience navigating complex payer requirements.

This individual will work collaboratively with providers, coders, financial counselors, and leadership to ensure timely and accurate claim resolution while supporting the overall financial health of the organization.

Key Responsibilities:

Claims & Denial Management

Manage payer-specific denial and accounts receivable work queues, processing approximately 70 claims daily.
Investigate unpaid, denied, and underpaid claims to secure appropriate reimbursement.
Research denial reasons and determine the appropriate corrective action.
Identify and resolve claim issues related to coding, authorizations, eligibility, medical necessity, bundling edits, and payer-specific requirements.
Work escalated, high-dollar, and aged accounts requiring advanced review and resolution.
Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer policies, and reimbursement guidelines.

Appeals Management

Prepare and submit first-level, second-level, and complex appeal letters with supporting documentation.
Monitor appeal deadlines and ensure timely submission of all required materials.
Communicate with insurance carriers regarding appeal status and claim reconsiderations.
Partner with providers and coding staff to obtain documentation necessary to support appeals.
Track appeal outcomes and identify opportunities to improve reimbursement success rates.

Revenue Recovery & Analysis

Identify opportunities for additional reimbursement and revenue recovery.
Review payer contracts and reimbursement methodologies when investigating payment discrepancies.
Research payer policies and coverage determinations to support claim resolution efforts.
Analyze denial trends and recommend corrective actions to prevent future denials.
Assist leadership in identifying root causes of reimbursement challenges and developing solutions.

Documentation & Communication

Maintain detailed and accurate account documentation within the practice management system.
Respond to inquiries regarding claim status, denials, appeals, and reimbursement activity.
Communicate professionally with insurance carriers, providers, and internal departments.
Provide updates on complex accounts and reimbursement issues to management.

Collaboration & Process Improvement

Partner with coding, registration, authorization, and clinical teams to resolve claim issues and improve workflows.
Participate in meetings regarding payer updates, reimbursement changes, and denial trends.
Assist with training and mentoring team members regarding denial management and appeal strategies.
Contribute to process improvement initiatives aimed at reducing denials and increasing reimbursement efficiency.

Additional Responsibilities

Perform other related duties as assigned to support revenue cycle operations.

Qualifications:

Education & Experience:
- High school diploma or GED required.
- Minimum of two (2) years of experience in medical billing, insurance follow-up, denial management, accounts receivable, or revenue cycle operations.
- Experience working insurance denials, appeals, medical necessity denials, authorization denials, and payer-specific reimbursement issues.
- Experience interpreting EOBs, ERAs, payer policies, and reimbursement guidelines.
- Orthopedic billing experience preferred.
- Associate degree or equivalent healthcare revenue cycle experience preferred.
- Experience with payer contract analysis and reimbursement recovery preferred.
Skills & Abilities:
- Strong understanding of medical billing, insurance reimbursement, and denial management.
- Knowledge of Medicare, Medicaid, Workers' Compensation,…