The Onyx Group - Denial & AR Follow-Up Specialist

Job Title: Denials & AR Follow-Up Specialist

Weekly Hours: 40 hours per week, Schedule Options (Onsite): Monday – Friday, 8:00 AM – 5:00 PM (1-hour lunch) or  Monday – Friday, 8:00 AM – 4:30 PM (30-minute lunch)

Supervised by: Denials & AR Follow-Up Team Lead / Revenue Cycle Manager

Position Overview:

The Denials & AR Follow-Up Specialist is responsible for the analysis, follow-up, and resolution of denied, underpaid, and unpaid insurance claims to maximize reimbursement and reduce outstanding accounts receivable. This role serves as a subject matter expert in payer reimbursement methodologies, denial management, appeals processing, and revenue recovery strategies.

The Denials & AR Follow-Up Specialist performs complex account research, identifies root causes impacting reimbursement, prepares appeals, and collaborates with internal departments to resolve barriers to payment. This position plays a critical role in protecting organizational revenue through effective denial prevention, reimbursement recovery, and accounts receivable management.

Responsibilities:

Denials Management

· Review, analyze, and resolve denied claims across commercial, government, and managed care payers.

· Identify denial root causes including coding, authorization, eligibility, credentialing, registration, documentation, and payer processing issues.

· Prepare and submit first-level, second-level, and complex appeals within payer filing deadlines.

· Obtain and review medical records, referrals, authorizations, operative reports, and supporting documentation necessary for appeal submissions.

· Monitor appeal status and perform ongoing follow-up until final claim resolution.

· Escalate payer trends and unresolved denial issues as appropriate.

Accounts Receivable Follow-Up

· Maintain an assigned inventory of accounts receivable and work accounts according to departmental productivity and aging standards.

· Perform comprehensive account research to identify barriers preventing reimbursement.

· Contact insurance carriers through payer portals, correspondence, and direct communication to resolve outstanding balances.

· Pursue payment on denied, partially paid, and unpaid claims.

· Identify and resolve reimbursement discrepancies, payment variances, and payer processing errors.

· Ensure all follow-up activities are documented accurately and timely within the billing system.

Revenue Recovery & Reimbursement Analysis

· Analyze Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer correspondence, and contractual reimbursement expectations.

· Investigate underpayments and payment variances to ensure accurate reimbursement.

· Review payer guidelines, contracts, and policies to support reimbursement recovery efforts.

· Recommend corrective actions to improve reimbursement outcomes and reduce future denials.

· Identify opportunities for revenue recovery and process improvement.

Root Cause Analysis & Denial Prevention

· Identify recurring denial trends and reimbursement obstacles.

· Partner with Coding, Credentialing, Registration, Authorizations, Cash Posting, Credits, and Billing teams to resolve systemic issues.

· Provide feedback regarding operational, workflow, or system issues contributing to denials.

· Participate in denial prevention initiatives and revenue cycle improvement projects.

· Assist leadership in identifying opportunities to improve clean claim rates and reduce accounts receivable aging.

System Utilization & Documentation

· Utilize Epic and/or eClinicalWorks (eCW) to review claim activity, account history, and reimbursement information.

· Utilize Waystar, FinThrive, payer portals, and other revenue cycle technologies to research and resolve claims.

· Maintain accurate and complete account documentation supporting all actions taken.

· Ensure account notes support audit readiness and operational transparency.

Compliance & Quality

· Maintain compliance with CMS regulations, payer requirements, HIPAA standards, and organizational policies.

· Ensure appeals and follow-up activities meet payer filing deadlines.

· Maintain high levels of accuracy, quality, and productivity.

· Support internal and external audit requests as needed.

Key Outcomes / Performance Expectations

· Reduction in aged accounts receivable inventory.

· Increased denial overturn and appeal success rates.

· Timely resolution of denied, underpaid, and unpaid claims.

· Recovery of reimbursement that may otherwise be written off.

· Accurate account documentation and claim follow-up activities.

· Identification and communication of denial trends and systemic reimbursement issues.

· Achievement of productivity, quality, and aging performance goals.

Required Education & Certifications:

· High School Diploma or equivalent required.

· Associate's or Bachelor's degree preferred.

· Minimum of 3–5 years of healthcare revenue cycle experience required.

· Minimum of 2 years of direct experience in denials management, insurance follow-up, accounts receivable resolution, or reimbursement recovery required.

· Experience working with physician practice billing, professional claims, and multi-specialty healthcare organizations preferred.

Knowledge & Skills

· Advanced knowledge of healthcare reimbursement methodologies and insurance claims processing.

· Strong understanding of denial management, appeals processes, and payer regulations.

· Working knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical necessity requirements.

· Ability to interpret EOBs, ERAs, payer policies, and reimbursement guidelines.

· Strong analytical and critical thinking skills.

· Excellent problem-solving and root cause analysis abilities.

· Strong organizational skills with the ability to manage a high-volume workload.

· Effective written and verbal communication skills.

Systems Experience

Preferred experience with:

· Epic

· eClinicalWorks (eCW)

· Waystar

· FinThrive

· Insurance payer portals

· Microsoft Excel and reporting tools

Certifications

· Certified Revenue Cycle Representative (CRCR) or willingness to obtain.

Success Metrics

· Accounts receivable dollars resolved.

· Denial overturn percentage.

· Appeal success rate.

· Reduction in AR aging.

· Reimbursement dollars recovered.

· Productivity and quality scores.

· Compliance with payer filing deadlines.

· Accuracy and completeness of account documentation.

Physical Demands:

Continuously requires sitting, typing, verbal communication.

Frequently requires reaching outward, reaching above the shoulder, lifting items weighing 10 pounds or less, pushing/pulling items weighing 10 pounds or less.

Infrequently requires pushing/pulling items weighing up to 50 pounds, pushing/pulling items weighing above 50 pounds, lifting items weighing up to 50 pounds, lifting items weighing up to 20 pounds, squatting/kneeling, bending, crawling. bending, and climbing.

Work Environment:

Person may be exposed to fumes, airborne particles, infectious diseases, blood/bodily fluids, and disease-bearing specimens.

The Onyx Group is an Equal Opportunity Employer.