Account Resolution Specialist II

This is a fully remote position, open to applicants in Arizona, +21 more locations.

📋 Description

• Oversee insurance claims for healthcare clients, ensuring precise and timely processing of payments.

• Address claim denials, appeals, account follow-up, collections, self-pay account resolutions, customer service, and comprehensive account management.

• Manage accounts receivable from claim billing through to final resolution.

• Support government or commercial payer portfolios, including Medicare, Medicaid, Medicare Advantage, Veterans Affairs, Workers' Compensation, and commercial health plans.

• Submit medical claims in accordance with federal, state, and payer-specific regulations.

• Review and rectify claim edits, errors, and denials.

• Investigate and analyze claim discrepancies and rejections, implementing necessary corrections.

• Follow up with payers to collect assigned insurance accounts receivable.

• Monitor updates from payers and changes in processes.

• Assess reasons for non-payment and resolve claims accordingly.

• Prepare and submit first- and second-level appeals with the required documentation.

• Identify and document issues related to coding, clinical matters, and registration for referral to the appropriate teams.

• Escalate stalled claims to payers or Currance leadership as needed.

• Verify and adjust claims to ensure accurate client account liabilities and balances.

• Communicate payer-specific issues to the team and management.

• Perform additional duties as assigned to meet business needs.

• Achieve 100% of the project's daily productivity goal and maintain a 90% monthly quality assurance score.

⛳️ Requirements

• High school diploma or equivalent is required.

• At least 2 years of experience in securing medical claim payments from health insurance companies.

• Experience in managing claim follow-ups and appealing denied claims with healthcare vendors or providers.

• Familiarity with EMR/EHR systems such as Meditech, Epic, Cerner, Allscripts, NextGen, or similar platforms.

• Strong working knowledge of ICD-10, CPT/HCPCS, payer guidelines, and the revenue cycle process.

• Excellent written and verbal communication skills, with the ability to effectively advocate with payers.

• Proficient in Microsoft Office Suite, Teams, and various desktop applications.

• Understanding of basic coding principles and payer-specific billing requirements.

• Knowledge of regulations and rules pertaining to Healthcare Revenue Cycle administration.

• Skilled in investigating medical accounts.

• Ability to validate payments.

• Capacity to make decisions and take appropriate actions.

• Quick learner with collaboration and messaging tools.

• Ability to work independently and achieve results with minimal supervision.

• Must meet a productivity goal of 100% of the project's daily objectives.

• Must achieve a quality goal of 90% monthly quality assurance score.

• Candidates will undergo criminal background checks, employment verification, and government exclusion checks as a condition of employment or engagement.

🏝️ Benefits

• Remote position.

• Team coverage hours typically span from 7:30 AM to 7:30 PM CST.

• Criminal background check, employment verification check, and mandatory government exclusion check are conducted as part of the hiring process.