Surgical AR Representative

Spire Orthopedic Partners

. Manage aging accounts receivable specific to orthopedic and spine surgical claims .

Posted 11/3/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $24 - $36 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing accounts receivable for orthopedic and spine surgical claims, with a strong focus on denial management, appeals processes, and compliance with payer guidelines. Proficient in analyzing claims, drafting appeals, and collaborating with coding teams to optimize reimbursement outcomes.

Highest-signal resume keywords

Orthopedic Surgical Claims ManagementDenial Management ExperienceCPT, ICD-10, HCPCS KnowledgeCPC CertificationHigh-Volume Account Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Accounts Receivable ManagementClaims ReviewAppeals DraftingPayment Variance IdentificationEOB AnalysisContractual Discrepancy ResolutionMedical Necessity InvestigationBundling Error IdentificationModifier UsagePrior Authorization Denial Resolution

Soft Skills

Analytical AbilityProblem-SolvingDetail OrientationPersistenceIndependent Decision-Making

Certifications & Qualifications

CPC Certification

Industry Keywords

Orthopedic SurgerySpine SurgeryPayer GuidelinesHIPAA ComplianceWorkers’ CompensationMedicareCommercial PayersNCCI EditsHigh-Dollar AccountsSurgical Reimbursement

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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)