AR Follow-Up & Appeals Specialist

We are seeking experienced AR Follow-Up & Appeals Specialists to support claim resolution, payer follow-up, denial management, appeals, reconsiderations, and recovery of outstanding accounts receivable for a high-volume medical practice.

This role is responsible for working unpaid, denied, underpaid, rejected, and pending claims through final resolution. The ideal candidate should be able to investigate claim issues, communicate with payers, prepare appeals, document findings clearly, and escalate complex or repeated denial patterns to management.

Key Responsibilities:

• Work outstanding accounts receivable by payer, aging bucket, balance, denial category, and timely filing/appeal deadline.
• Research claim status using payer portals, clearinghouse systems, billing software, and direct payer communication.
• Follow up on unpaid, denied, underpaid, rejected, or pending claims through resolution.
• Review payer responses, denial codes, claim edits, EOB/ERA details, and supporting documentation.
• Prepare and submit corrected claims, reconsiderations, appeals, disputes, and supporting documentation.
• Identify root causes of non-payment, including eligibility issues, COB, authorization problems, medical necessity denials, coding/modifier issues, credentialing/enrollment issues, documentation requests, timely filing, and payer processing errors.
• Contact insurance companies through portals and phone calls to obtain claim status, denial details, reconsideration requirements, and appeal instructions.
• Document payer responses clearly, including representative names, call reference numbers, dates, next steps, and expected turnaround times.
• Track appeal and reconsideration status until final payer determination.
• Prioritize claims based on aging, financial impact, payer deadlines, and recovery potential.
• Escalate repeat denials, second denials, unresolved payer issues, and high-dollar claims to management with a clear summary of findings.
• Maintain AR trackers, appeal logs, denial follow-up logs, and daily work reports.
• Support process improvement by identifying recurring payer issues and internal workflow gaps.

Qualifications & Experience:

Required

• Prior experience in medical billing AR follow-up, denial management, appeals, reconsiderations, or insurance follow-up.
• Strong understanding of the full claim lifecycle from submission to final resolution.
• Ability to read and interpret EOBs, ERAs, denial codes, payer correspondence, claim status responses, and appeal requirements.
• Working knowledge of eligibility and coordination of benefits, prior authorization, timely filing, corrected claims, medical necessity, secondary claims, appeals and reconsiderations, payer escalation, and provider enrollment or credentialing-related denials.
• Experience using payer portals, clearinghouses, billing platforms, and spreadsheet-based AR trackers.
• Strong analytical, documentation, communication, and follow-up skills.
• Ability to work independently, prioritize high-value claims, and manage deadlines.

Preferred

• Experience in orthopedics, physical therapy, radiology, surgery, DME, Medicare, commercial insurance, and out-of-network billing.
• Familiarity with systems such as ModMed / EMA, TriZetto, Availity, Office Ally, Medicare portals, UHC, BCBS, Cigna, Aetna, and other payer portals.
• Experience handling complex denials, payer escalations, bulk claim reviews, appeal tracking, and high-volume AR.
• Understanding of authorization mismatches, provider taxonomy issues, medical documentation requests, underpayments, and payer-specific appeal processes.

Ideal Candidate:

The ideal candidate is investigative, persistent, and organized. This person should be able to determine why a claim has not paid, identify the correct next step, communicate effectively with payers, document every action clearly, and follow the claim until it is resolved.

This role requires more than basic claim follow-up. We are looking for someone who can understand denial patterns, escalate payer issues appropriately, and help improve AR recovery.

To Apply:

Please submit your resume with relevant experience in AR follow-up, denial management, appeals, reconsiderations, payer communication, and medical billing systems.

EEO Disclosure:

iOrtho is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.