Account Resolution Specialist III

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

📋 Description

• Oversee insurance claims for clients, ensuring precise and prompt payment processing.

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

• 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.

• Remain updated on payer developments and process modifications.

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

• Prepare and submit first- and second-level appeals along with supporting documentation.

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

• Escalate stalled claims to payers or Currance leadership.

• Verify and adjust claims to ensure client accounts reflect accurate liability and balances.

• Recognize payer-specific issues and communicate them to the team and manager.

• Achieve 100% of the project's daily goal.

• Attain a 90% monthly quality assurance score.

• Execute additional duties assigned to support business needs.

⛳️ Requirements

• High school diploma or equivalent.

• A minimum of 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 advocate effectively with payers.

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

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

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

• Skilled in investigating medical accounts.

• Ability to validate payments.

• Capable of decision-making and taking action.

• Ability to quickly learn and utilize collaboration and messaging tools.

• Capacity to work independently and achieve results with minimal oversight.

• Subject to criminal background and government exclusion checks as a condition of employment or engagement.

🏝️ Benefits

• Remote position.

• Criminal background check and government exclusion check as part of the hiring process.