Revenue Cycle Specialist

Description

About AICA Orthopedics

AICA Orthopedics is Atlanta's premier integrated healthcare provider, with 21 locations and a state-of-the-art surgery center. For 25 years, we have delivered exceptional multidisciplinary orthopedic, neuro-spine, and pain management care through a team of 400+ professionals. Our Revenue Cycle team is the financial engine that keeps it all running.

Position Impact

The Back-End Revenue Cycle Specialist is responsible for the downstream functions that convert billed services into collected revenue. This role sits at the critical intersection of accounts receivable management, denial resolution, payment reconciliation, and collections follow-up — directly determining how much of what we bill we actually get paid.

Where front-end staff open the door for clean claims, you are the one who makes sure payment comes through it. Your accuracy in posting, your persistence in collections, and your analytical approach to AR aging are what separate billed revenue from collected revenue.

When hired, you will be placed in one primary function — AR follow-up, collections, or payment posting — based on your experience and team need. This posting exists to connect us with qualified candidates across all three areas.

Core Responsibilities

Accounts Receivable Management

• Work AR aging reports daily, prioritizing accounts by balance, payer, and days outstanding to maximize recovery
• Identify and resolve claim holds, rejections, and unpaid balances within established follow-up timeframes
• Contact payers via phone, portal, and correspondence to obtain claim status and drive resolution
• Escalate accounts approaching timely filing limits or contractual deadlines to prevent revenue write-off
• Maintain accurate AR notes and document all account activity, contacts, and next steps in the system
• Reduce days in AR for assigned payer segments through consistent, systematic follow-up

Denial Management & Appeals

• Review explanation of benefits (EOBs) and remittance advice to identify denial reason codes and determine the correct resolution path
• Research and appeal denied or underpaid claims using supporting clinical documentation, medical records, and payer policy knowledge
• Recognize denial patterns across payers and accounts and escalate systemic issues to prevent recurring revenue loss
• Track appeal outcomes and adjust strategies based on payer-specific trends and timely filing windows
• Coordinate with billing, coding, and clinical teams to obtain documentation needed to support successful appeals

Payment Posting & Reconciliation

• Post insurance payments, adjustments, and contractual write-offs accurately against patient accounts from EOBs and ERAs
• Identify and work underpayments by reconciling posted amounts against contracted fee schedules
• Balance daily payment batches and resolve discrepancies between posted and deposited amounts
• Process secondary claim submissions following primary payer adjudication
• Apply patient payments and coordinate with patient accounts team on balance billing as needed
• Ensure all posting is completed within established daily and weekly productivity targets

Collections Follow-Up

• Conduct systematic outbound follow-up on outstanding insurance and patient balances
• Communicate professionally with payer representatives, attorney offices, and patients to resolve account balances
• Identify accounts appropriate for escalation, write-off review, or bad debt referral per departmental policy
• Meet or exceed monthly collection targets for assigned payer portfolios or account queues
• Document all collection activity and maintain accurate account statuses in NextGen and Salesforce

Reporting & Process Improvement

• Generate and interpret AR aging, denial, and collection reports to identify trends and opportunities
• Surface recurring root causes — coding errors, authorization gaps, credentialing issues — to the appropriate team for upstream correction
• Contribute to departmental performance goals for clean claim rates, collection percentages, and days in AR
• Support audits and payer reconciliation projects as assigned

Performance Expectations

Success is measured by outcomes. Top performers in this role consistently:

• Reduce days in AR for assigned accounts through disciplined, timely follow-up
• Achieve strong appeal overturn rates through thorough documentation and payer knowledge
• Post payments accurately with minimal corrections or batch discrepancies
• Meet or exceed monthly collection targets for assigned payer queues
• Proactively identify systemic issues and escalate before they compound across multiple accounts

Qualifications

Required

• 2+ years of experience in back-end medical billing, AR follow-up, payment posting, or insurance collections
• Working knowledge of EOBs, ERAs, remittance advice, and denial reason codes
• Understanding of insurance reimbursement processes, contracted rates, and medical billing workflows
• Proficiency with MS Office, particularly Excel; experience with practice management or EHR systems
• Strong analytical and problem-solving skills with a detail-oriented, follow-through mindset
• Ability to manage a high-volume account queue independently while meeting productivity and accuracy standards

Preferred

• Experience with NextGen, Salesforce, or similar healthcare/CRM platforms
• Background in orthopedic, neuro-spine, physical therapy, or personal injury billing
• Knowledge of personal injury med pay, major medical, and lien-based billing environments
• Familiarity with secondary claim submission and coordination of benefits processes
• CPC, CPMA, CRCR, or other revenue cycle certification (or actively pursuing)
• Bilingual in Spanish and English (preferred)

The Ideal Candidate

You treat your AR queue like a case file — every account has a story and you are going to work it until it's resolved. You know the difference between a denial you can appeal and one that needs a different fix upstream. You post payments with precision because you understand that a bad post creates a ripple of problems. You are persistent without being reactive, organized without being rigid, and analytical enough to see patterns that others miss.

Compensation & Benefits

• Competitive hourly rate commensurate with experience
• Performance-based bonus potential
• Comprehensive benefits: medical, dental, vision, 401(k)
• Professional development support including certification assistance and continuing education
• Clear advancement pathway: Senior Specialist ? Team Lead ? Manager

Work Environment

• 40 hours per week; occasional extended hours during peak periods or month-end close
• In-office position based at AICA Orthopedics headquarters in Marietta, GA
• Fast-paced, metrics-driven environment with clear performance expectations
• Collaborative team structure with experienced revenue cycle leadership

AICA Orthopedics / ProCo LLC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Requirements

Required

2+ years of experience in back-end medical billing, AR follow-up, payment posting, or insurance collections

Working knowledge of EOBs, ERAs, remittance advice, and denial reason codes

Understanding of insurance reimbursement processes, contracted rates, and medical billing workflows

Proficiency with MS Office, particularly Excel; experience with practice management or EHR systems

Strong analytical and problem-solving skills with a detail-oriented, follow-through mindset

Ability to manage a high-volume account queue independently while meeting productivity and accuracy standards

Preferred

Experience with NextGen, Salesforce, or similar healthcare/CRM platforms

Background in orthopedic, neuro-spine, physical therapy, or personal injury billing

Knowledge of personal injury med pay, major medical, and lien-based billing environments

Familiarity with secondary claim submission and coordination of benefits processes

CPC, CPMA, CRCR, or other revenue cycle certification (or actively pursuing)

Bilingual in Spanish and English (preferred)