Job Overview

 This role ensures accurate and timely initial payor claim submission and payment by reviewing and correcting claim edits, rejections and rebills. They are expected to have hands-on account resolution, maintaining the highest standards of quality, productivity, and compliance on an individual and team basis. Ability to work claims for multiple clients and systems. 

Job Duties and Responsibilities

· Submit hospital medical claims in accordance with federal, state and payer mandated guidelines. 

· Research, analyze, and review hospital claim errors and rejections and make applicable corrections. 

· Ensure proper hospital claim submission and payment through review and correction of claim edits, errors, and denials. 

· Maintain required knowledge of payer updates and process modifications to ensure accurate claims. 

· Investigate, follow up with payers, and work claims as assigned. 

· Determine reason for non-covered charges and take appropriate action. 

· Perform posting billing adjustments. 

· Ensure billing reroutes are worked timely and comply with company procedures. 

· Escalate stalled hospital claims to manager. 

· Identify and communicate payer specific issues to the team and leadership. 

· Participate and contribute to daily shift briefings. 

· Comply with productivity standards while maintaining quality levels. 

· Receptive to feedback and continual performance improvement, and willingness to grow and learn. 

· Punctual, dependable, and adapt easily to change. 

· Strong character by demonstrating accountability and responsibility.

· Perform work duties using ethical decision-making processes. 

· Other job duties as assigned.

Requirements and Qualifications

 · High school diploma or equivalent required; Associate degree preferred 

· 4+ years of work experience working with health insurance companies in securing payment for medical claims. 

· 3+ years of work experience with billing hospital claims and filing appeals with health insurance companies. 

· Experience using clearing houses systems such as Waystar, Quadex, SSi or similar platforms for billing. 

· Proficiency in Microsoft Office Suite, Teams, and various desktop applications. 

Knowledge, Skills & Abilities

 · Knowledge of coding guidelines for claim errors. 

· Understanding of Healthcare Revenue Cycle administration rules and regulations. 

· Knowledge of ICD-10 diagnosis and procedure codes as well as CPT/HCPCS codes. 

· Strong investigative skills to identify and resolve reasons for non-payment on medical accounts. 

· Proficiency in computers and Microsoft Office Suite/Teams, with experience using GoToMeeting/Zoom. 

· Ability to make informed decisions and take appropriate action. 

· Demonstrates a positive attitude and pleasant demeanor at work. 

· Willingness to learn, grow, and respond constructively to feedback for continuous improvement. 

· Professional interaction with colleagues and punctual, dependable work habits. 

· Ability to adapt easily to change and perform duties with ethical decision-making. 

· Demonstrates accountability, responsibility, and accomplishments in the revenue cycle process. 

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.