AR Specialist

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Tennessee. TOA concentrates on diagnosing and treating disorders and injuries of the musculoskeletal system, allowing our patients to live their best lives. Ninety-plus years later, we are advancing the practice of orthopaedic surgery throughout the state.

The AR Specialist is an essential part of the TOA Central Business Office. As an AR Specialist, you will use your analytical, financial, and customer service skills to ensure that TOA claims filed to an insurance payer are processed accurately and in a timely manner.

• Promptly identify any errors or other issues in claims processing.
• Effectively follow up on any unpaid balances.
• Expeditiously bring any remaining balance to resolution.
• Meet quality assurance and productivity standards by identifying and reconciling insurance balance accounts.
• Identify denial trends and provide potential solutions while analyzing patient accounts utilizing our EPM system – Next Gen to determine appropriate action.
• Review explanations of benefits details on denials.
• Communicate with insurance payer representatives, patients, and TOA staff to ensure timely and accurate resolution of account transactions. This would include Commercial plans, Medicare/Medicare HMO plans, Medicaid/Medicaid HMO plans, and BCBSTN.
• Prioritize assigned accounts to maximize aged accounts receivable resolution.
• Review the explanation of benefit (EOB) documentation and notate accounts on collection activity to perform account resolution.
• Operate within established guidelines and protocols, including providing backup documentation for our accounting and audit functions.
• Collaborate closely with the Central Business Office, clinical colleagues, and administrative teammates to develop a cohesive, high-performing team.
• Adhere to HIPAA and OSHA safety guidelines.

• Exceptional customer service and patient focus.
• Knowledge of insurance – particularly coordination of benefit rules and denial overturns are essential to this position.
• Knowledge of administrative and clerical procedures.
• Accustomed to using mostly payer websites for appeals/reconsiderations, medical records attachments, verification of benefits, and/or web-based claims follow-up.
• Ability to communicate and work as a team.
• Demonstrated proficiency with Microsoft Office programs such as Excel, Word, and Outlook.
• At least 3 years insurance collections experience.
• Experience using Next Gen.
• Orthopaedic specialty experience.
• Fluency in English is required; fluency in a second language is a plus.

AR Specialist will be assigned to work in TOA’s Central Business Office at an assigned cubicle in a call center environment and from home occasionally. The department experiences high volume, and as a result, it has associated stressors that conflict with a fast‑paced environment. The noise level in the work environment is moderate to loud, with other staff members answering phones and collaborating.

The position requires frequent computer use, repeating the same movements when entering data, reading from a computer screen for extended periods, standing and walking around the office, and occasionally standing, stooping, and lifting or moving objects weighing approximately 20-25 pounds up to 40-50 pounds.

TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers.