The Resolution-Based ASC A/R Specialist is an experienced insurance follow-up and denial-resolution professional who owns assigned ambulatory surgery center accounts through final resolution. This role is designed for a self-sufficient detective who can analyze the complete claim story—including billing, payment posting, EOB/ERA details, payer requirements, CPT and modifier implications, and prior account activity—to determine the correct next action and move the claim toward payment. The specialist must do more than document claim status: they must identify the root cause, take or coordinate the appropriate corrective action, and prevent avoidable timely filing or appeal-limit losses.
This is primarily the Insurance A/R Follow-Up / Denial Specialist lane—not a data-entry biller, payment poster, patient collections representative, or coder. The successful candidate must understand those functions well enough to identify downstream issues and communicate a specific, well-researched resolution request to the appropriate team.
Key Responsibilities
- Own assigned surgery center accounts and work all unpaid, underpaid, partially paid, rejected, and denied insurance balances to resolution.
- Review a scheduled workload and complete a minimum of 45 actionable accounts per day while maintaining quality, accurate documentation, and meaningful next steps.
- Investigate claim status through payer portals, electronic inquiries, telephone follow-up, EOBs/ERAs, correspondence, and internal account history.
- Analyze denials and payment variances to determine whether the cause is payer processing, authorization, eligibility, medical necessity, coding, modifier usage, bundling, contractual allowance, billing, claim submission, or payment posting.
- Identify partial-payment scenarios at the line-item level; determine why one or more CPT lines remain unpaid rather than repeatedly noting that the claim processed and paid.
- Take timely corrective action, including corrected claims, reconsiderations, appeals, documentation requests, payer escalation, or referral to the biller/coder/payment-posting team with a specific researched finding.
- Prepare complete appeal packages and medical-claim appeals when required; route documents for printing or center submission when system permissions require client-team assistance.
- Work facility claims for multi-specialty ambulatory surgery centers, which may include orthopedics, total joints, gastroenterology, ophthalmology, pain management, and other surgical specialties.
- Interpret EOBs and payer responses for both in-network and out-of-network services to validate payment allocation, denial rationale, patient responsibility, and appropriate follow-up.
- Recognize recurring payer, verification, coding, billing, or posting trends and promptly communicate them to leadership with examples and recommended prevention steps.
- Maintain detailed, accurate account notes, status codes, follow-up dates, and resolution documentation that support downstream reporting and audit review.
- Review and respond to emails and internal requests throughout the workday; acknowledge requests promptly and provide realistic completion timelines.
- Adapt quickly when reassigned between surgery centers, states, payer mixes, systems, or specialties based on operational need.
- Follow HIPAA, client policies, payer rules, and all applicable compliance and confidentiality requirements.
Qualifications
- High school diploma or GED required; associate or bachelor's degree in business, healthcare, or a related field preferred.
- Minimum of 3 years of recent healthcare revenue cycle experience with strong insurance A/R follow-up and denial-resolution responsibilities.
- Demonstrated ability to independently resolve complex claims rather than rely on step-by-step direction.
- Working knowledge of the full claim lifecycle: charge entry/billing, claim submission, clearinghouse edits, payment posting, insurance follow-up, denials, appeals, and account reconciliation.
- Proficiency reading EOBs/ERAs and understanding CPT, ICD-10-CM, HCPCS, modifiers, denial codes, payer policies, and medical-necessity concepts at a follow-up level.
- Experience with commercial payers, Medicare, Medicaid, and payer portals; ability to learn state-specific and payer-specific requirements quickly.
- Strong written and verbal communication, analytical reasoning, attention to detail, and time-management skills.
- Comfort working in multiple client systems, remote desktops/servers, payer portals, communication platforms, and computer-based phone systems simultaneously.
- Direct ambulatory surgery center (ASC) facility-billing and collections experience.
- Multi-specialty ASC exposure, especially orthopedics, total joints, GI, ophthalmology, and pain management.
- Experience with AdvantX, HST, Vision, SIS Complete, Availity, Waystar, or comparable ASC/payer platforms.
- Experience researching underpayments, contract-related variances, out-of-network claims, refunds, and complex appeals.
- Background in a fast-paced billing company or centralized revenue cycle environment supporting multiple facilities or states.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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