AR And Denial Management

Position Overview:

The AR Follow-up & Denial Management Specialist is responsible for the timely resolution of unpaid, underpaid, and denied medical claims to maximize reimbursement and reduce accounts receivable (AR) aging. This role analyzes denials, identifies root causes, and drives corrective actions including claim resubmissions, appeals, and payer follow-up. The position partners cross-functionally with billing, coding, authorization, and vendor teams to resolve issues impacting reimbursement and overall revenue cycle performance. In addition to transactional responsibilities, this role supports trend analysis, workflow optimization, and performance improvement initiatives. Success in this role requires strong analytical skills, payer knowledge, and the ability to manage high-volume workloads while maintaining accuracy and compliance. Performs other duties as assigned.

Job Roles & Responsibilities:

Follow up on unpaid, underpaid, and denied claims across commercial, Medicare, and Medicaid payers • Review Explanation of Benefits (EOB/ERA) to validate denial and underpayment reasons • Analyze denial trends, identify root causes, and implement corrective actions • Correct claims and submit resubmissions, reconsiderations, and appeals based on payer requirements and contract terms • Generate and track appeals, ensuring appropriate documentation and adherence to payer guidelines • Communicate with payers and internal teams (coding, billing, prior authorization) to resolve claim issues • Maintain accurate and detailed documentation of all follow-up activities in compliance with HIPAA and payer requirements • Escalate payment variances, trends, and systemic issues to leadership • Track outcomes of claims, appeals, and payment resolutions to ensure performance goals are met • Utilize job aids, SOPs, and payer guidelines to ensure consistent and accurate processing • Support development and improvement of workflows, processes, and tracking mechanisms • Participate in weekly/monthly performance reviews, reporting on trends, risks, and opportunities • Collaborate with cross-functional teams and vendor partners to improve reimbursement outcomes • Serve as a subject matter resource for denial management processes and payer requirements • Stay current on billing, coding, and payer policy changes impacting revenue cycle performance

Qualifications & Requirements:

Experience & Education

3 years of experience in medical billing, AR follow-up, or denial management within U.S. healthcare • Experience with prior authorization, payer utilization management policies, and appeals preferred • Healthcare-related degree or equivalent experience

Skills & Competencies 

• Strong analytical and problem-solving skills with a focus on root cause identification • Ability to identify trends, develop insights, and communicate findings clearly • Excellent verbal and written communication skills • Strong organizational and time management skills with the ability to manage multiple priorities • Ability to work independently and collaboratively in a fast-paced environment • Strong attention to detail and commitment to accuracy • Ability to think critically and understand downstream revenue cycle impact • Maintains strict confidentiality of sensitive patient and financial information

Performance Expectations

• Consistently meet or exceed productivity and quality benchmarks • Drive timely resolution of claims to improve cash flow and reduce AR aging Credence Resource Management v2.0 Effective – April 8, 2026 • Proactively identify and escalate trends impacting reimbursement • Ensure compliance with payer guidelines and regulatory requirements • Contribute to continuous improvement initiatives and workflow optimization

Key KPI’s

AR days reduction • Denial overturn rate • First-pass resolution rate • Net collection rate • Productivity and quality scores