Insurance Denials Specialist

Description

INSURANCE DENIALS SPECIALIST

Maximize Reimbursements Through Strategic Problem-Solving

Location: AICA Orthopedics Headquarters - Marietta, GA
Department: Revenue Cycle

Reports To: Insurance Collections Manager

Position Impact

The 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 Responsibilities

Strategic Denial Management

• Analyze denied claims to identify specific reasons for rejection and determine optimal resolution paths
• Apply in-depth knowledge of payer policies, medical coding, and documentation requirements to craft effective appeals
• Implement systematic follow-up protocols based on payer-specific timelines and requirements
• Document all actions, communications, and resolution steps with meticulous attention to detail
• Track denial patterns to help identify and address systemic issues

Proactive Reimbursement Optimization

• Verify insurance benefits and secure necessary pre-authorizations to prevent future denials
• Review and correct claim errors prior to submission when possible
• Ensure all supporting documentation meets payer requirements for efficient processing
• Reconcile payments against fee schedules to identify and address underpayments
• Coordinate with clinical teams to obtain required documentation for successful appeals

Technical Problem Resolution

• Research complex claim issues using multiple information systems and payer portals
• Apply detailed understanding of medical terminology and procedural requirements
• Implement systematic approaches to resolve similar denials efficiently
• Maintain current knowledge of changing payer policies and requirements
• Apply critical thinking to develop solutions for unusual or complex reimbursement challenges

Performance Expectations

Success in this role is measured by specific outcomes:

• Meeting or exceeding monthly insurance recovery targets
• Reducing average days in accounts receivable for assigned payers
• Achieving strong appeal success rates through proper documentation and follow-up
• Resolving assigned claims within established timeframes
• Contributing to department's overall collection goal achievement

Qualifications & Skills

Required

• 2+ years experience in medical billing, insurance collections, or revenue cycle
• Demonstrated success in denial management and claim resolution
• Strong understanding of insurance reimbursement processes and medical coding
• Excellent  analytical and problem-solving abilities
• Methodical approach to documentation and follow-up
• Proficiency with NextGen, Salesforce, or similar healthcare/CRM systems
• Attention to detail and commitment to accuracy

Preferred

• Experience with orthopedic, neurology, or physical therapy billing
• Knowledge of personal injury cases and related insurance processes
• Certification in medical billing or revenue cycle management (CPC, CPMA, etc.)
• Background in healthcare administration or finance

The Ideal Candidate

• Approaches insurance recovery with the precision and thoroughness of an investigator
• Demonstrates methodical persistence in pursuing appropriate reimbursement
• Shows analytical thinking in identifying patterns and root causes of denials
• Maintains exceptional organization to manage multiple accounts simultaneously
• Communicates clearly and effectively with internal teams and payer representatives

Rewards & Growth Opportunities

• Competitive hourly rate with potential for performance-based incentives
• Clear path for advancement to Senior Specialist, Team Lead, or Management roles
• Comprehensive benefits including medical, dental, vision, and 401(k)
• Professional development and specialized certification opportunities
• Ability to contribute directly to the financial health of a growing healthcare organization

About AICA Orthopedics

AICA 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!

Requirements

Required

• 2+ years experience in medical billing, insurance collections, or revenue cycle
• Demonstrated success in denial management and claim resolution
• Strong understanding of insurance reimbursement processes and medical coding
• Excellent analytical and problem-solving abilities
• Methodical approach to documentation and follow-up
• Proficiency with NextGen, Salesforce, or similar healthcare/CRM systems
• Attention to detail and commitment to accuracy