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 Accounts Receivable Specialist IV, your responsibility is to  review, correct, and resolve claim edits, errors, and resolve accounts to  support reliable revenue flow. You serve as a subject matter expert,  handling denials, appeals, and account follow-up for multiple payer  types while working with a high degree of independence. This role  requires advanced payer knowledge, strong problem-solving skills, and  the ability to navigate complex medical claims from start to finish with  minimal oversight. ARSIVs are expected to consistently deliver accurate  and timely results while meeting or exceeding productivity and recovery  targets. You will address accounts involving multiple denial layers, high dollar claims or bulk projects. You are expected to model best practices, share expertise with colleagues, and identify process improvements that strengthen the overall account resolution function. 

 This role will focus exclusively on hospital/facility claims and work within the EMR system Paragon. Will need to work PST hours.  

Job Duties and Responsibilities:

•  Independently manage high-dollar, aged, and complex accounts requiring advanced research and payer knowledge to maximize revenue. 
• Address escalated or delayed claims, especially those requiring extensive payer, technical, or clinical review.
• Analyze and resolve high-value, complex claims according to payer specific guidelines and regulations. 
• Negotiate payment and resolution directly with payer representatives when standard channels are ineffective. 
• Mentor other account resolution specialists, focusing on advanced cases and strategic solutions. 
• Submit claims and appeals in compliance with Federal, State, and payer-mandated regulations, keeping up with any changes. 
• Consistently meet and exceed productivity and quality standards in claims resolution. 
• Research and correct claim errors and denials, implementing solutions to prevent repeat issues. 
• Maintain expert knowledge of payer policies and process updates; train team members to ensure compliance and accuracy. 
• Investigate and follow up with payers to collect outstanding insurance accounts receivables. 
• Adjust claims as needed so account balances and liabilities are correctly represented. 
• Lead and participate in continuous improvement efforts to enhance claim resolution processes. 
• Detect payer trends or policy changes that may impact reimbursement and communicate findings to leadership and to team during shift briefings. 
• Perform additional duties as assigned to meet evolving business needs.
• Productivity: Achieve 125% of the project daily goal. 
• Quality: Achieve 95% monthly quality assurance score. 
• Other expectations: As outlined by the department. 

Qualifications:

•  High school diploma or equivalent required; Associate's degree preferred 
• Bachelor’s degree in healthcare management or related field preferred. 
• CRCR certification or completion of certification required within 90 days of hire. 
• Minimum 5 years of experience securing medical claim payments from health insurance companies, experience managing claim follow-up and appeals with healthcare vendors or providers. 
• Demonstrated experience with complex insurance claims, high dollar denials, and escalation strategies to obtain payment. 
• Minimum 3+ years of experience using Artiva for account resolution workflows preferred. 
• Experience using EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms to support billing and account resolution. 
• Proficiency in Microsoft Office Suite, Teams, and various desktop  applications.

Knowledge, Skills, and Abilities:

• Knowledge of ICD-10 Diagnosis and procedure codes and CPT/HCPCS codes.
• Knowledge of rules and regulations relative to Healthcare Revenue Cycle administration.
• Skills in investigating medical accounts and resolving claims.
• Ability to validate payments.
• Ability to make decisions and act.
• Ability to learn and use collaboration tools and messaging systems.
• Ability to maintain a positive outlook, a pleasant demeanor, and act in the best interest of the organization and the client.
• Ability to research healthcare revenue cycle rules and regulations
• Ability to take professional responsibility for quality and timeliness of work product.

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.