Denial Management Specialist – Orthopedic Services

About the role

This is a fully remote, full-time position supporting orthopedic revenue cycle and denial management operations.

Responsibilities

• Understand the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals.
• Support billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties.
• Review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues.
• Prepare professional appeal letters and communicate effectively with payers.
• Manage a high-volume workload and meet payer deadlines.

Requirements

• CPC, CCS, CPMA, or similar certification preferred, but not required.
• CPB certification preferred.
• Minimum of three years of professional healthcare revenue cycle experience.
• Professional experience in both medical billing and medical coding required.
• Experience with denial management, claims resolution, accounts receivable follow-up, appeals, or payer correspondence.
• Experience with Epic, Athena, NextGen, eClinicalWorks, or comparable healthcare systems.
• Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, medical necessity requirements, and payer reimbursement policies.
• Experience working with commercial insurance, Medicare, Medicaid, self-funded health plans, payer portals, and claim follow-up workflows.
• Ability to review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues.
• Strong written communication skills with experience preparing professional appeal letters.
• Strong analytical, organizational, and problem-solving abilities.
• Proficiency in Microsoft Excel, Word, and Outlook.

Qualifications

All team members are direct-hire W-2 employees. We offer stable, long-term employment, comprehensive benefits, supportive leadership, and opportunities for professional growth.

Skills

Strong written communication skills, ability to independently manage a high-volume workload, and proficiency in Microsoft Office.

Benefits

Competitive compensation, comprehensive benefits package, supportive leadership, and opportunities for professional growth.

Pay

Details TBA.

Schedule

Full-time, remote position.