Company Overview:
Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management practice providing comprehensive clinical, surgical, and imaging services. With locations across Georgia, North Carolina, South Carolina, Tennessee, Florida, and Texas, our team is committed to delivering exceptional, patient-centered care through collaboration, innovation, and clinical excellence. As one of the largest single-specialty pain management practices in the nation, SSJC continues to expand its network while investing in the people who make our success possible. We are seeking an experienced Medical Billing AR/Denials Lead who can provide day-to-day guidance to the billing team while remaining actively involved in accounts receivable, denial management, and revenue cycle operations.
Position Summary:
The Medical Billing AR/Denials Lead serves as a senior resource for the billing team and supports the daily operations of accounts receivable and denial management. This position is responsible for assisting with workflow coordination, monitoring productivity and outstanding AR, identifying denial and payer trends, providing guidance to team members, and escalating complex issues to management. The Lead will maintain an active workload while helping ensure team priorities, productivity expectations, quality standards, and departmental goals are consistently met.
Leadership & Team Responsibilities:
Serve as a day-to-day resource and point of contact for assigned AR and denial team members.
Assist management with coordinating daily workflows, priorities, and work assignments.
Monitor team productivity, outstanding accounts, denial activity, and aging AR to identify areas requiring additional attention.
Provide guidance and support to team members regarding complex claims, denials, appeals, payer requirements, and account resolution.
Assist with training and onboarding new team members and provide ongoing coaching on departmental processes and expectations.
Review work for accuracy, completeness, and adherence to established billing and revenue cycle procedures.
Identify workflow challenges, recurring errors, and opportunities for process improvement and communicate recommendations to management.
Monitor outstanding assignments and follow up with team members to support timely completion.
Help reinforce departmental expectations regarding productivity, documentation, communication, and accountability.
Escalate significant payer issues, operational concerns, performance trends, or unresolved accounts to the Billing Manager as appropriate.
Assist management with reports regarding team productivity, AR performance, denial trends, and other departmental metrics.
Promote collaboration, professionalism, and effective communication across the billing team.
Accounts Receivable & Denial Management Responsibilities:
Maintain an active AR workload while working to maximize collections and minimize aging accounts receivable.
Process insurance denials and appeals to support timely account resolution.
Review AR aging and prioritize accounts requiring follow-up.
Follow up with insurance carriers regarding unpaid claims, underpayments, overpayments, corrected claims, appeals, and outstanding denials.
Analyze denial trends and provide management with summaries of identified issues, root causes, and potential corrective actions.
Review and initiate payer and patient refunds as appropriate.
Ensure issues, sources, follow-up activity, and actions taken are appropriately documented on each account.
Identify and report payer-specific denial trends requiring escalated follow-up.
Create and assist with reports regarding the status of patient accounts, collections, denials, and AR performance.
Address inquiries from insurance companies, patients, providers, and internal departments.
Review claim information for completeness and accuracy.
Process paper zero-pay denials and ensure documentation is appropriately entered into the system.
Verify patient benefits and eligibility when necessary.
Maintain applicable denial and productivity tracking tools.
Ensure compliance with HIPAA and organizational requirements when handling patient and business information.
Qualifications:
Minimum of 4 years of medical accounts receivable, billing, denial management, or revenue cycle experience, with demonstrated advanced knowledge of AR follow-up and claim resolution.
Previous Lead, Senior Billing Specialist, Team Lead, Trainer, or other demonstrated leadership experience strongly preferred.
Experience providing guidance, training, or workflow support to other team members.
Experience with Medicare, Medicaid, commercial insurance plans, Workers' Compensation, and Personal Injury cases.
Knowledge of claims submission and reimbursement related to office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
Strong understanding of medical billing rules, including coordination of benefits, modifiers, EOBs, appeals, and ANSI denial codes.
Strong knowledge of CPT and ICD-10 coding and medical pre-certification protocols.
Ability to analyze AR and denial trends and communicate findings effectively to team members and management.
Strong organizational, problem-solving, and decision-making skills.
Ability to appropriately prioritize competing departmental needs and escalate issues when necessary.
Excellent written and verbal communication skills.
Ability to provide constructive feedback and direction professionally and respectfully.
Strong computer skills, including Microsoft Office.
Comfortable working in a growing, dynamic organization and navigating changing priorities.
Self-motivated with the ability to manage an individual workload while supporting team operations.
Bachelor's degree preferred.
Experience using eClinicalWorks preferred.
Pain Management experience preferred.
Preferred Location:
While this is a remote position, preference will be given to candidates residing in one of the following states:
- Georgia
- TexasNorth Carolina
- South Carolina
FloridaCandidates located in Georgia should be able to attend meetings or training at our Lawrenceville administrative office as needed.
Compensation & Benefits:
This is a full-time position offering a competitive salary, paid time off (PTO), comprehensive health benefits, and a 401(k) with company match.
Essential Professional Expectations:
The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, and vendors, including in busy, demanding, or stressful circumstances. The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period; manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, or coworkers' work; and use established de-escalation and escalation procedures when appropriate. The employee must exercise sound judgment; maintain appropriate workplace boundaries; receive and respond to routine feedback and direction; protect confidential patient and business information; and address patient or workplace concerns through established supervisory and safety procedures. These functions are essential to the position. As a Lead, the employee is also expected to model these professional standards for the team and support management in reinforcing appropriate communication, accountability, and departmental expectations.
