Account Resolution Specialist II

Job Description

Job Description

Description: We are hiring in the following states: AR, AZ, CA, CO, FL, GA, IA, IL, LA, MO, NC, NE, NJ, NV, OK, PA, SD, TN, TX, VA, WA, and WI This is a remote position .

Job Overview:

As a healthcare revenue cycle business, we manage insurance claims and oversee timely claim resolution and payment processing for our clients. As an Account Resolution Specialist II, your main responsibility is to manage insurance claims for clients, ensuring that payments are processed accurately and in a timely manner. This role involves handling claim denials, appeals, and account follow-up for a variety of payer sources, all of which help maintain the financial stability of the healthcare organizations served.

Job Duties and Responsibilities:

• Submit medical claims in accordance with all federal, state, and payer-specific requirements.
• Ensure claims are correctly submitted and paid by reviewing and correcting edits, errors, and denials.
• Investigate and analyze claim errors and rejections to apply necessary corrections.
• Follow up with payers and collect assigned insurance accounts receivable.
• Stay informed about payer updates and process changes for accurate claims submission and follow-up.
• Evaluate reasons for non-payment and take appropriate action to resolve claims for clients.
• Prepare and submit first- and second-level appeals with supporting documentation in accordance with payer guidelines and timelines.
• Identify and document coding, clinical, and registration issues for referral to the appropriate teams to correct claim errors and prevent future denials.
• Escalate stalled claims to the payer or Currance leadership as needed.
• Verify and adjust claims so that client accounts reflect correct liability and balances.
• Transforming revenue cycle differently.
• Improving healthcare together.
• Identify issues specific to payers and communicate them to the team and manager.
• Perform other duties assigned to support business needs.
• Productivity: Achieve 100% of the project daily goal.
• Quality: Achieve 90% monthly quality assurance score.
• Other expectations: As outlined by the department.

Qualifications:

• High school diploma or equivalent.
• Minimum 2 years of experience securing medical claim payments from health insurance companies, experience managing claim follow-up and appealing denied claims with healthcare vendors or providers.
• Experience using EMR/EHR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms to support billing and account resolution.
• Strong working knowledge of ICD-10, CPT/HCPCS, payer guidelines, and the revenue cycle process.
• Strong written and verbal communication skills, with ability to advocate effectively with payers.
• Proficiency in Microsoft Office Suite, Teams, and various desktop applications.

Knowledge, Skills, and Abilities:

• Maintain current knowledge of basic coding principles, and payer-specific billing requirements to support claim resolution.
• Knowledge of regulations and rules related to Healthcare Revenue Cycle administration.
• Skilled in investigating medical accounts.
• Ability to validate payments.
• Capable of making decisions and taking action.
• Ability to quickly learn and use collaboration and messaging tools.
• Consistently maintain a positive attitude, pleasant demeanor, and act in the best interests of both the organization and clients.
• Take professional responsibility for the quality and timeliness of your work.
• Work independently and achieve results with minimal oversight.

Disclosure Statement:
As part of the Currance application and hiring experience, all candidates are subject to a criminal background check and a government exclusion check. The government exclusion check is a mandatory screening process that verifies whether an individual is listed on federal or state exclusion or watchlists, including but not limited to, the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM.gov).
These screenings are conducted to ensure compliance with applicable federal and state laws and regulations, to protect the integrity of federally funded programs, the clients we support, and to prevent participation by individuals who are excluded due to fraud, abuse, or other misconduct. By submitting an application, candidates acknowledge and consent to these checks as a condition of employment or engagement.