Job Overview

This role includes managing insurance claims for our hospital clients, ensuring timely resolution and payment processing. It also includes handling denials, appeals, and account follow-up across various payer types, contributing to the financial success of the healthcare organizations that we support.

Job Duties and Responsibilities

• Submit medical claims in accordance with federal, state, and payer mandated guidelines.
• Ensure proper claim submission and payment through review and correction of claim edits, errors, and denials.
• Research, analyze, and review claim errors and rejections towards applicable corrections.
• Investigate, follow up with payers, and collect the insurance accounts receivable as assigned.
• Maintain required knowledge of payer updates and process modifications to ensure accurate claims submission, processing, and follow up.
• Assess the reasons for payer non-payment and take the required actions to successfully resolve claims on behalf of our clients.
• Escalate stalled claims to payer or Currance leadership.
• Verify and adjust claims to ensure that client accounts accurately reflect the correct liability and balance.
• Identify any payer specific issues and communicate to team and manager.
• Other duties and responsibilities as assigned to meet Company business needs.

 Qualifications

• High school diploma or equivalent.
• One year experience working at Currance as an ARS I, 1+ years of inpatient/outpatient medical billing/follow-up experience within a hospital or vendor setting to secure insurance payments or AR resolution.
• One year of experience with hospital and/or physician claim follow-up and appeals with health insurance companies.
• Experience in one or more EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or comparable platforms is required.
• Proficiency with computers including Microsoft Office Suite/Teams, GoToMeeting/Zoom, etc.

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.
• Skilled in medical accounts investigation.
• 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 take professional responsibility for quality and timeliness of work product.
• Ability to achieve results with little oversight.

Please note that a background check and exclusion verification will be conducted for anyone hired with Currance.