A/R Specialist

A/R Specialist (Temp‑to‑Hire) Pay Rate $30/hr - $33/hr About The Role The A/R Specialist will manage both backlog claims and an ongoing assigned inventory. This position requires deep expertise in facility billing, orthopedic and spine claims, and a proactive, ownership‑driven approach to payer follow‑up. Successful candidates will be skilled at navigating payer policies, resolving denials, and accelerating reimbursement. Key Responsibilities Investigate and analyze claims by reviewing EOBs, provider notes, payer policies, and medical necessity guidelines. Research denied claims at both the claim and line‑item level, identifying root causes and required corrective actions. Perform root cause analysis using CARC/RARC codes to identify issues related to coding (CPT/ICD‑10/modifiers), medical necessity, authorizations, documentation, timely filing, and credentialing. Collaborate with billing vendors to communicate denial insights, documentation needs, and next steps for corrected claims or appeals. Track appeal outcomes and claim statuses using vendor workflows, A/R aging reports, and payer responses to ensure timely resolution. Identify denial trends across service lines and recommend process improvements or training to reduce future denials. Partner with cross‑functional RCM teams to address documentation or coding gaps and implement preventive measures. Maintain accurate documentation of claim actions, denial codes, tasks, and outcomes; prepare reports for leadership on trends and recovery performance. Ensure compliance with HIPAA, payer regulations, and internal audit standards. Required Qualifications 3–5 years of medical A/R, denial management, or revenue cycle experience, preferably in spine, orthopedics, ENT, or pain management. Facility claim experience (UB‑04 / 837I) required. Orthopedic experience required; spine experience strongly preferred. Demonstrated ability to review eligibility, coding (CPT, ICD‑10, HCPCS), modifiers, medical necessity, and authorization requirements. Strong understanding of CARC/RARC denial codes and payer reimbursement methodologies. Experience analyzing aging A/R, resolving underpayments, and advocating for provider reimbursement. Proficiency with denial/claim management systems, EMRs, spreadsheets, and payer portals. Skills & Competencies Excellent verbal and written communication skills. Strong interpersonal and customer service abilities. Highly organized with exceptional attention to detail. Effective time management and ability to meet deadlines. Strong analytical and problem‑solving skills. Ability to work in a fast‑paced, high‑volume environment. Proficiency in Microsoft Office Suite. #J-18808-Ljbffr The Judge Group