Insurance Denials Specialist (AR)

INSURANCE DENIALS SPECIALISTMaximize Reimbursements Through Strategic Problem-SolvingLocation: AICA Orthopedics Headquarters - Marietta, GAPosition ImpactThe Insurance Recovery Specialist plays a critical role in AICA Orthopedics' financial performance by systematically securing appropriate reimbursements across our 21 locations. This position requires methodical analysis, technical expertise, and persistent follow-up to ensure claims are processed correctly and paid in full. Your ability to navigate complex payer requirements, identify root causes of denials, and implement precise resolution strategies directly impacts the organization's revenue capture.Core ResponsibilitiesStrategic Denial ManagementAnalyze denied claims to identify specific reasons for rejection and determine optimal resolution pathsApply in-depth knowledge of payer policies, medical coding, and documentation requirements to craft effective appealsImplement systematic follow-up protocols based on payer-specific timelines and requirementsDocument all actions, communications, and resolution steps with meticulous attention to detailTrack denial patterns to help identify and address systemic issuesProactive Reimbursement OptimizationVerify insurance benefits and secure necessary pre-authorizations to prevent future denialsReview and correct claim errors prior to submission when possibleEnsure all supporting documentation meets payer requirements for efficient processingReconcile payments against fee schedules to identify and address underpaymentsCoordinate with clinical teams to obtain required documentation for successful appealsTechnical Problem ResolutionResearch complex claim issues using multiple information systems and payer portalsApply detailed understanding of medical terminology and procedural requirementsImplement systematic approaches to resolve similar denials efficientlyMaintain current knowledge of changing payer policies and requirementsApply critical thinking to develop solutions for unusual or complex reimbursement challengesPerformance ExpectationsSuccess in this role is measured by specific outcomes:Meeting or exceeding monthly insurance recovery targetsReducing average days in accounts receivable for assigned payersAchieving strong appeal success rates through proper documentation and follow-upResolving assigned claims within established timeframesContributing to department's overall collection goal achievementQualifications & SkillsRequired2+ years experience in medical billing, insurance collections, or revenue cycleDemonstrated success in denial management and claim resolutionStrong understanding of insurance reimbursement processes and medical codingExcellent analytical and problem-solving abilitiesMethodical approach to documentation and follow-upProficiency with NextGen, Salesforce, or similar healthcare/CRM systemsAttention to detail and commitment to accuracyIn-Office - Marietta, GAPreferredExperience with orthopedic, neurology, or physical therapy billingKnowledge of personal injury cases and related insurance processesCertification in medical billing or revenue cycle management (CPC, CPMA, etc.)Background in healthcare administration or financeThe Ideal CandidateApproaches insurance recovery with the precision and thoroughness of an investigatorDemonstrates methodical persistence in pursuing appropriate reimbursementShows analytical thinking in identifying patterns and root causes of denialsMaintains exceptional organization to manage multiple accounts simultaneouslyCommunicates clearly and effectively with internal teams and payer representativesRewards & Growth OpportunitiesCompetitive hourly rate with potential for performance-based incentivesClear path for advancement to Senior Specialist, Team Lead, or Management rolesComprehensive benefits including medical, dental, vision, and 401(k)Professional development and specialized certification opportunitiesAbility to contribute directly to the financial health of a growing healthcare organizationAbout AICA OrthopedicsAICA Orthopedics is Atlanta's premier integrated healthcare provider specializing in orthopedic, neuro-spine, and pain management services. With 21 locations across metro Atlanta, we deliver multidisciplinary care through a collaborative team of specialists including orthopedic surgeons, neurologists, chiropractors, physical therapists, and pain management experts.Ready to apply your analytical expertise to maximize insurance reimbursements while advancing your career in healthcare finance? Apply now!RequirementsRequired2+ years experience in medical billing, insurance collections, or revenue cycleDemonstrated success in denial management and claim resolutionStrong understanding of insurance reimbursement processes and medical codingExcellent analytical and problem-solving abilitiesMethodical approach to documentation and follow-upProficiency with NextGen, Salesforce, or similar healthcare/CRM systemsAttention to detail and commitment to accuracyIn-Office - Marietta, GAPreferredExperience with orthopedic, neurology, or physical therapy billingKnowledge of personal injury cases and related insurance processesCertification in medical billing or revenue cycle management (CPC, CPMA, etc.)Background in healthcare administration or finance

Created: 2026-04-02