AR Specialist - Parkwest Surgery Center

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Tennessee, specializing in diagnosing and treating disorders and injuries of the musculoskeletal system. With over 90 years of service, TOA operates 20+ locations across the state, fostering stability, impactful work, a positive environment, and comprehensive total rewards.

About the role

This AR Specialist role is an essential part of the TOA Parkwest Surgery Center. You will use analytical, financial, and customer service skills to ensure accurate and timely processing of TOA claims filed to insurance payers.

Responsibilities

• Promptly identify errors or issues in claims processing.
• Follow up on unpaid balances and expedite resolution of remaining balances.
• Meet quality assurance and productivity standards by reconciling insurance balance accounts.
• Identify denial trends and provide solutions while analyzing patient accounts using Nextgen EPM system.
• Review explanations of benefits (EOB) details on denials.
• Communicate with insurance payer representatives, patients, and TOA staff to resolve account transactions, including Commercial, Medicare/Medicare HMO, Medicaid/Medicaid HMO, and BCBSTN plans.
• Prioritize assigned accounts to maximize resolution of aged accounts receivable.
• Review EOB documentation and notate accounts for collection activity.
• Provide backup documentation for accounting and audit functions.
• Collaborate with the Central Business Office, clinical colleagues, and administrative teammates to build a cohesive, high-performing team.
• Adhere to HIPAA and OSHA safety guidelines.

Requirements

• Exceptional customer service and patient focus.
• Knowledge of insurance, particularly coordination of benefit rules and denial overturns.
• Familiarity with administrative and clerical procedures.
• Experience using payer websites for appeals, reconsiderations, medical records attachments, verification of benefits, and web-based claims follow-up.
• Ability to communicate and work as a team.
• Proficiency with Microsoft Office programs (Excel, Word, Outlook).
• At least 3 years of insurance collections experience.
• Experience using NextGen.
• Orthopaedic specialty experience (preferred).
• Fluency in English; a second language is a plus.

Benefits

• Comprehensive medical and dental coverage.
• Paid Time Off (PTO).
• 401(k) plan with company match, safe harbor match, and profit-sharing match.

Schedule

Onsite, Monday – Friday, 7:30 AM – 4:00 PM.

Working Conditions

The role involves high-volume work in a fast-paced environment with associated stressors. Regular tasks include sitting for extended periods, computer work, data entry, clear verbal communication, and reading from a screen. Ability to differentiate colors, shades, and brightness is required.