Surgical AR Representative

Spire Orthopedic Partners; Turn of River (CT); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Growth opportunities

Dynamic work environment

Competitive compensation

Generous PTO

Health, dental, vision, 401(k)

Job summary

Spire Orthopedic Partners is seeking a Surgical AR & Denials Management Representative to resolve complex accounts receivable and payer denials related to orthopedic and spine surgical services. You will review high-dollar claims, identify underpayments, and draft detailed appeals with supporting documentation.

The role requires strong analytical skills, experience with CPT/ICD-10/NCCI guidelines, and the ability to navigate payer appeals.

Qualifications

• 3–5+ years of AR follow-up and denial management experience in physician practice or surgical specialty environment.
• Strong knowledge of CPT, ICD-10, HCPCS, NCCI edits, and modifier usage.
• Experience with commercial, Medicare, and Workers’ Compensation payers.

Responsibilities

• Manage aging accounts receivable for orthopedic and spine surgical claims.
• Review high-dollar surgical accounts and identify underpayments, bundling errors, and contractual discrepancies.
• Escalate claims through payer reconsideration and appeals processes.

Skills

AR follow-up

Denial management

Payer reimbursement

Analytical skills

Attention to detail

CPC certification

Education

CPC certification

Job description

Who we are:Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.What you’ll do:The Surgical AR & Denials Management Representative is responsible for the resolution of complex accounts receivable and payer denials related to orthopedic and spine surgical services. This role requires advanced knowledge of surgical coding, payer reimbursement methodologies, bundling rules, medical necessity criteria, and appeals strategy.The representative will manage high-dollar, complex surgical claims, aggressively pursue payer follow-up, draft detailed appeals, and partner with coding and clinical teams to prevent recurring denials. Preference will be given to candidates with experience in spine surgery reimbursement, including instrumented procedures and multi-level cases.This is a performance-driven, detail-oriented role requiring strong analytical skills and the ability to independently resolve complex reimbursement issues.Responsibilities/Duties: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 necessityBundling and NCCI editsModifier denialsGlobal period denialsDowncodingPrior authorization issuesDraft comprehensive, evidence-based appeals including supporting documentation.Track denial trends and escalate 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 fusionsInstrumentation and hardwareDecompression proceduresRevision surgeriesASC vs hospital reimbursement differencesReview 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.Who you are: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 knowledgeStrong written appeal drafting skillsAnalytical and problem-solving abilityPersistence and follow-throughDetail orientationAbility to manage high-volume, high-dollar accountsIndependent decision-making capabilityWhat we offer:Excellent growth and advancement opportunitiesDynamic environmentAccess to a diverse network of practitionersBroad infrastructure of tools and programs to enhance the employee experienceCompetitive CompensationGenerous PTOBenefits package: health, dental, vision, 401(k), etc.We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type of years and experience within the industry, education, etc.IND3