Orthopedic Surgical AR & Denials Specialist

Spire Orthopedic Partners; Stamford (CT); Presencial; USD 36 000 - 45 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive Compensation

Generous PTO

Health benefits

Dental benefits

Vision benefits

401(k)

Resumo da oferta

Spire Orthopedic Partners, based in Stamford, CT, is seeking an experienced Surgical AR & Denials Management Representative. You will resolve complex orthopedic and spine surgical claims, pursue payer follow-up and appeals, and collaborate with coding and clinical teams to reduce denials.

The ideal candidate has 3–5+ years in AR/denial management, with strong CPT, ICD-10, HCPCS, and NCCI knowledge. We offer competitive compensation, generous PTO, and a comprehensive benefits package including

Qualificações

• 3–5+ years of AR follow-up and denial management experience in physician practice or surgical specialty environment.
• Demonstrated experience with orthopedic surgical claims required.
• Spine surgery reimbursement experience strongly preferred.
• Strong knowledge of CPT, ICD-10, HCPCS, NCCI edits, and modifier usage.
• Experience with commercial, Medicare, and Workers’ Compensation payers.
• Ability to analyze EOBs and payer remittance advice in detail.
• CPC certification is preferred but not required.
• Advanced surgical reimbursement knowledge
• Strong written appeal drafting skills
• Analytical and problem-solving ability
• Persistence and follow-through
• Detail orientation
• Ability to manage high-volume, high-dollar accounts
• Independent decision-making capability

Responsabilidades

• Manage aging accounts receivable specific to orthopedic and spine surgical claims.
• Perform detailed review of high-dollar surgical accounts.
• Identify underpayments, bundling errors, and contractual discrepancies.
• Escalate claims through payer reconsideration and appeals processes.
• Maintain timely follow-up in accordance with payer filing limits.
• Investigate and resolve denials including: Medical necessity, Bundling and NCCI edits, Modifier denials, Global period denials, Downcoding, Prior authorization issues.
• Draft comprehensive, evidence-based appeals including supporting documentation.
• Track denial trends and elevate systemic issues to management.
• Participate in payer peer-to-peer or escalation discussions as needed.
• Understand reimbursement for complex orthopedic and spine procedures including: Multi-level spinal fusions, Instrumentation and hardware, Decompression procedures, Revision surgeries, ASC vs hospital reimbursement differences.
• Review operative reports to validate coding and appeal strategy.
• Collaborate with coding team on documentation improvement opportunities.
• Review payer contracts to validate expected reimbursement.
• Identify payment variances and contractual underpayments.
• Assist in recovery of underpaid claims.
• Monitor timely filing and appeal deadlines.
• Maintain detailed account notes reflecting follow-up actions.
• Ensure appeals and follow-up actions meet compliance standards.
• Adhere to HIPAA and payer guidelines.

Conhecimentos

AR follow-up

denial management

orthopedic claims

spine reimbursement

CPT knowledge

ICD-10 knowledge

HCPCS knowledge

NCCI edits

modifier usage

Formação académica

High School or Equivalent

Ferramentas

CPC certification

Descrição da oferta de emprego

Spire Orthopedic Partners, based in Stamford, CT, is seeking an experienced Surgical AR & Denials Management Representative. You will resolve complex orthopedic and spine surgical claims, pursue payer follow-up and appeals, and collaborate with coding and clinical teams to reduce denials.

The ideal candidate has 3–5+ years in AR/denial management, with strong CPT, ICD-10, HCPCS, and NCCI knowledge. We offer competitive compensation, generous PTO, and a comprehensive benefits package including