Job Description

About Optima

Optima Medical is an Arizona-based medical group consisting of 34 locations and over 150+ medical providers, who care for more than 200,000 patients. Our mission is to improve the quality of life throughout Arizona and Nevada by helping communities "Live Better, Live Longer" through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.

Position Summary: The A/R Specialist is responsible for managing accounts receivable (A/R), reviewing and correcting denied or rejected claims, and ensuring timely follow-up with insurance carriers. This role requires strong knowledge of healthcare payer guidelines, claim workflows, and primary care billing practices.

Responsibilities

Claims Management

• Follow up on insurance claims to ensure timely and accurate payment.
• Review, research, and correct denied or rejected claims; resubmit as necessary.
• Communicate with insurance carriers to resolve claim issues and discrepancies.
• Work claims through final resolution, not just follow-up activity, ensuring appropriate reimbursement or adjustment.
• Independently research and resolve complex claim denials, including medical necessity, coding-related denials, appeals, and payer escalations.
• Identify payer trends and provide feedback to management.
• Identify recurring denial patterns and provide feedback to management on opportunities to prevent future denials.
• Navigate insurance portals to verify claim status, eligibility, and payer notes.
• Maintain accurate and detailed documentation of all claim activity, denials, appeals, and adjustments.
• Identify and escalate credentialing or contracting issues.

Denials & Follow-Up

• Maintain an organized follow-up bucket with accurate claim status and next actions.
• Review and resolve daily denials assigned by remit code per payer and company guidelines, including:
• Bundled or Non-Covered Services
• Lack of Medical Necessity
• Insurance Eligibility / Demographic Issues
• Out-of-Network / Credentialing
• Modifiers, POS, CLIA #
• Manage and aggressively work aging A/R balances, including claims exceeding 90 and 120 days, to ensure timely resolution and payment.
• Analyze recurring denial trends and collaborate with internal teams to identify root causes and reduce repeat denials.

Qualifications

• Minimum 3–5 years of experience in medical billing, denials management, and A/R follow-up, preferably with experience handling complex A/R accounts and denials.
• Primary Care (PCP) billing experience preferred.
• Demonstrated experience independently researching and resolving complex denials, appeals, and payer escalations.
• Experience managing aging accounts receivable, including claims aged 90+ and 120+ days.
• Strong understanding of EOBs, ERAs, payer rules, denial resolution strategies, and revenue cycle processes.
• Experience working with claim management and EHR systems.
• Experience with eClinicalWorks (eCW) is preferred.
• Excellent communication, organization, analytical, and problem-solving skills.

Why Join Our Team?

• Substantial growth opportunities
• Leadership and mentoring
• Fun work environment (happy hours, lunches, events, holiday parties)
• Comprehensive benefits (medical, vision, dental, 401k, paid holidays)
• Supportive and positive work environment