AR & Payor Relations Specialist

Overview

Pedes Orange County is seeking a detail-oriented AR & Payor Relations Specialist to oversee insurance follow-up, denial management, and cash collections for our growing vascular practice. This role is responsible for ensuring claims are processed accurately, denials are resolved efficiently, and revenue is collected in a timely manner to maintain healthy cash flow.

In addition to leading AR operations, this position provides secondary support in payor credentialing and payor contracting to ensure uninterrupted billing capability and network participation across all service lines.

Accounts Receivable, Revenue Cycle & Collections

• Assist with payment posting and tracking
• Perform follow-up on unpaid, underpaid, and rejected insurance claims
• Resolve claim denials through correction, resubmission, and formal appeals
• Reconcile bank accounts

Payor & Patient Communication

• Contact insurance carriers via phone and payer portals to resolve claim discrepancies
• Verify payment accuracy against contracted fee schedules
• Assist patients with billing questions, balances, and payment arrangements
• Document all payer and patient communications in the billing system

Revenue Integrity & Reporting

• Review EOBs and remittance advice for accuracy
• Ensure correct use of CPT, ICD-10, and HCPCS coding in coordination with clinical and billing teams
• Provide reporting on AR metrics, denial categories, and payer performance
• Escalate systemic reimbursement issues to leadership

Payor Contracting & Payor Credentialing Support

This role supports payor credentialing and payor contracting operations to maintain active network participation and uninterrupted billing capability. Provider credentialing is not within the scope of this role.

• Assist with Medicare, Medi-Cal, Medicare Advantage, and commercial payer enrollments
• Support payor credentialing applications and re-credentialing processes at the organizational/group level
• Track payer contract expirations and renewals
• Support communication with payers, IPAs, and facilities regarding participation status
• Maintain organized payor credentialing and contracting documentation

Reporting & Accountability

• Maintain accurate AR documentation and tracking logs
• Support reduction of aging >90 days
• Track denial resolution and appeal outcomes
• Ensure payor enrollment status supports uninterrupted billing
• Provide visibility into reimbursement risks and payer-related revenue impacts

Qualifications

• 2 years of experience in medical billing, accounts receivable, revenue cycle, or insurance follow-up
• Working knowledge of Medicare, Medi-Cal, Medicare Advantage, and commercial payer reimbursement
• Familiarity with ICD-10, CPT, HCPCS, EOBs, and remittance advice
• Experience with payer portals, clearinghouses, and EHR/practice management systems
• Strong organizational skills, follow-through, and problem-solving ability

Education

• High School Diploma or GED (Required)
• College Degree or 2 years of Relevant Experience (Preferred)
• Payor Credentialing or Contracting Certification (Preferred but not required)

Key changes made:

• Removed all references to provider credentialing (licenses, DEA, board certifications, CAQH, PECOS, NPI, malpractice, etc.) as a responsibility
• Reframed the credentialing section explicitly as payor credentialing and payor contracting
• Added a clear disclaimer that provider credentialing is outside this role's scope
• Updated the certification preference to reflect payor-focused work rather than provider credentialing