Surgical AR Representative

🔥 1 minute ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $24 - $36 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Spire Orthopedic Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2021

🏥 Healthcare

🤝 B2B

🏢 Enterprise

Healthcare • B2B • Enterprise

Spire Orthopedic Partners is a forward-looking capital and management partner for leading orthopedic and spine surgeons, operating as a management services organization (MSO) that provides administrative infrastructure and strategic support. The company partners with high-growth orthopedic practices across the Northeastern United States (Connecticut, New York, Massachusetts, Rhode Island), enabling around 165 physicians and 1,800 employees across 40 locations to grow, specialize, and focus on patient care while Spire handles operations, practice integration, and business development.

📋 Description

• 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 medical necessity, bundling/NCCI, modifier, global period, downcoding, and prior authorization denials • Draft comprehensive, evidence-based appeals with supporting documentation • Track denial trends and escalate systemic issues to management • Participate in payer peer-to-peer or escalation discussions as needed • Review operative reports to validate coding and appeal strategy • Collaborate with coding teams 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

🎯 Requirements

• 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 strongly preferred • Advanced surgical reimbursement knowledge • Strong written appeal drafting skills • Analytical and problem-solving ability • Persistence and follow-through • Detail orientation • Ability to manage high-volume, high-dollar accounts • Independent decision-making capability • High School or Equivalent education level

🏖️ Benefits

• Excellent growth and advancement opportunities • Dynamic environment • Access to a diverse network of practitioners • Broad infrastructure of tools and programs to enhance the employee experience • Competitive Compensation • Generous PTO • Health, dental, and vision benefits • 401(k)

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