AR Follow-Up Representative - Authorization & Code Updates

Job Details: Level: Experienced, Job Location: Center City 833 Chestnut - Philadelphia, PA, Position Type: Full Time, Education Level: High School, Salary Range: Undisclosed, Job Shift: Day Shift, Position Summary
The AR Follow-Up Representative – Authorization & Code Updates is responsible for researching, correcting, and resolving healthcare claims that are delayed or denied due to missing, incorrect, expired, or mismatched authorization information and coding requirements. This role works closely with insurance payers, clinical/authorization teams, coding departments, and internal billing staff to ensure claims are accurately updated and resubmitted for timely reimbursement.
The ideal candidate has strong knowledge of medical billing, insurance authorizations, claim denials, CPT/HCPCS codes, ICD-10 codes, payer requirements, and electronic claim workflows. The representative must be highly detail-oriented, persistent, and comfortable communicating with insurance companies to resolve complex accounts.
Key Responsibilities

Perform daily AR follow-up on outstanding healthcare claims with a primary focus on authorization-related denials and billing issues.
Review claim denials, payer correspondence, EOBs/ERAs, and account notes to identify authorization and coding discrepancies.
Research and identify missing, incorrect, expired, or mismatched authorization numbers.
Contact insurance payers to verify authorization requirements, authorization status, approved services, dates of service, units, procedures, and associated authorization codes.
Obtain updated authorization information from payer representatives, authorization departments, referring providers, and internal clinical teams.
Update authorization numbers and related claim information accurately within the billing/practice management system.
Review CPT/HCPCS codes and modifiers against authorization information to identify discrepancies that may result in claim denials.
Coordinate with coding, clinical, registration, scheduling, and authorization departments to correct claim issues.
Submit corrected claims, reconsiderations, appeals, and supporting documentation when appropriate.
Track accounts through the payer's claims process and conduct timely follow-up until payment or final resolution is received.
Maintain detailed and accurate account notes documenting payer conversations, reference numbers, authorization details, claim status, and next steps.
Identify recurring authorization and coding denial trends and communicate issues to management and appropriate operational departments.
Escalate accounts requiring additional research or payer intervention according to department guidelines.
Meet established productivity, quality, aging, and cash-collection goals.
Maintain knowledge of payer-specific authorization and billing requirements.
Protect patient confidentiality and comply with HIPAA and applicable healthcare regulations.

Authorization & Coding Responsibilities
This position has a specialized focus on ensuring that authorization information and billed services are aligned. Responsibilities may include:

Comparing authorization records against billed CPT/HCPCS codes.
Identifying services billed outside the authorized scope.
Verifying authorized dates of service and number of approved units.
Identifying authorization numbers that were entered incorrectly or associated with the wrong service.
Researching retroactive authorization opportunities when permitted by the payer.
Requesting authorization corrections or updates from appropriate departments.
Determining when a corrected claim, reconsideration, or appeal is the appropriate resolution.
Ensuring updated authorization information is reflected accurately before claim resubmission.
Monitoring payer-specific authorization requirements and changes.

Qualifications

High school diploma or equivalent required; additional healthcare or medical billing education preferred.
2+ years of healthcare AR, medical billing, claims follow-up, or denial management experience.
Experience working with insurance payers and provider claims.
Strong understanding of CPT, HCPCS, ICD-10, and medical billing terminology.
Knowledge of insurance authorization processes and payer requirements.
Experience working with EOBs, ERAs, claim forms, and corrected claims.
Familiarity with payer portals and electronic claim submission systems.
Strong analytical and problem-solving skills.
Excellent verbal and written communication skills.
Strong attention to detail and ability to identify discrepancies between authorization and billing information.
Ability to prioritize a high volume of accounts while meeting productivity and quality expectations.
Proficiency with Microsoft Office and healthcare billing/practice management systems.

Preferred Qualifications

Experience specifically handling authorization-related denials.
Experience with authorization code corrections and claim resubmissions.
Knowledge of payer-specific authorization requirements.
Experience with Medicare, Medicaid, commercial insurance, and managed care plans.
Certified Medical Biller (CMB), Certified Professional Coder (CPC), or similar certification is a plus.
Experience with denial management and appeals.
Strong understanding of medical necessity and authorization-related claim edits.

Performance Expectations
Success in this role will be measured by:

Reduction in authorization-related AR aging.
Timely and accurate account follow-up.
Successful resolution of authorization and coding-related denials.
Correct and timely updating of authorization information.
Clean claim resubmission rates.
Increased collections and reduced outstanding AR.
Accurate documentation of account activity.
Productivity and quality standards.
Identification and communication of recurring payer issues.

Location: 

fully remote, but candidates must reside in DE, FL, GA, MD, NC, NJ, PA, SC, or TX

Hours: 

Monday - Friday: 8:00am - 4:30pm 

Pay Range: 

$19.00/hr - $23.00/hr

Our Commitment to Employees

Come work at Rothman Orthopaedics! Our employees are our single greatest asset, as such, we strive to provide a professional, nurturing environment where every member of our team can make a meaningful difference in the lives of others. This commitment to our employees has earned us the distinction as a Top Workplace in Philadelphia by the Philadelphia Inquirer year after year. Our employees enjoy competitive pay, comprehensive health and dental benefits, tuition reimbursement, paid time off, and retirement savings plans.

 Rothman Orthopaedics is an Equal Opportunity employer committed to providing opportunities to all qualified applicants without regards to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. We value developing an inclusive and equitable environment that strengthens our organization and allows us to better attract and retain a diverse workforce that is representative of our patients and our community. We model our values by creating and enacting practices that encourage participation from all backgrounds, perspectives, and experiences. 
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