Account Resolution Specialist IV – HB/PB (HST & DHT & MTS Time Zone Only)

We are hiring in the following states:
AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, ME, MN, MO, NC, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI

Remote position open to all US applicants, with preference given to Hawaii residents due to time zone and client alignment. .
Candidates who meet the minimum qualifications will be required to complete a video prescreen to move forward in the hiring process.

Hourly Rate: Up to $26.00/hour based on experience

At Currance, we believe in recognizing the unique skills and experiences that each candidate brings to our team. Our overall compensation package is competitive and is determined by a combination of your experience in the industry and your knowledge of revenue cycle operations. We are committed to offering a rewarding environment that aligns with both individual contributions and our company goals.

Benefits include paid time off, 401(k) plan, health insurance (medical, dental, and vision), life insurance, paid holidays, training and development opportunities, a focus on wellness and support for work-life balance, and more.

Please note that we are looking for people who have hospital billing experience in collections and have some HB billing experience, in high dollar collections, adjustments and denials management.

Time Zone Requirement: This position follows Hawaii Standard Time (HST) schedule. Applicants located outside of Hawaii must be available to work an 8-hour shift from 5:00AM to 5:00PM (HST). Hawaii does not observe Daylight Saving Time (DST), so candidates in other time zones will need to adjust their schedules accordingly in March and November to remain aligned with HST.

Work hour equivalents for 5:00AM to 5:00PM HST

Daylight Savings Time
8:00 AM to 8:00 PM Pacific
9:00 AM to 9:00 PM Mountain
10:00 AM to 10:00 PM Central
11:00 AM to 11:00 PM Eastern

Standard Time
7:00 AM to 7:00 PM Pacific
8:00 AM to 8:00 PM Mountain
9:00 AM to 9:00 PM Central
10:00 AM to 10:00 PM Eastern
Job Overview

Resolve complex medical claims. Subject matter expert for account resolution specialists across various payer types. Support financial success of healthcare clients by leveraging expertise to improve processes and outcomes. Drive improvements across all levels of account resolution through mentorship and knowledge-sharing.

Job Duties and Responsibilities
• Execute advanced tasks to drive revenue by resolving complex accounts for clients.
• Address and resolve the high-level escalated or delayed claims, including cases with extensive payer, technical, or clinical review requirements.
• Analyze and resolve high-dollar, high-complexity claims, ensuring compliance with payer-specific guidelines and regulations.
• Mentor all account resolution specialists to elevate skills, focusing on complex cases and strategic approaches.
• Submit claims in accordance with Federal, State, and payer-mandated guidelines, ensuring strict adherence to changing regulations.
• Meet and exceed productivity standards while maintaining high-quality performance in claims resolution.
• Accountable for researching, analyzing, and correcting claim errors and rejections, and implementing strategies to minimize recurrences.
• Maintain expert-level knowledge of payer updates and process modifications, and train staff on critical changes to ensure team-wide compliance and accuracy.
• Investigate, follow up with payers, and resolve outstanding insurance accounts receivables to maximize revenue collection.
• Adjust claims to ensure client accounts accurately reflect the correct liability and balance.
• Lead and contribute to continuous improvement initiatives, identifying trends and opportunities to enhance claim resolution processes.
• Participate in and contribute to daily shift briefings with insights on complex claims and payer trends.
• Other duties and responsibilities as assigned to meet company business needs.

Qualifications
• Bachelor’s degree in healthcare management or related field preferred.
• 3+ years of supervising, mentoring, or coaching required.
• CRCR certification or completion of certification required within 90 days of hire.
• Minimum 3-5 years of experience working with health insurance companies in securing payment for complex medical claims.
• Minimum 3-5 years of experience working with a vendor or directly with hospitals and physician groups managing claims follow-up.
• Minimum 3+ years of experience using Artiva for account resolution workflows preferred.
• Demonstrated experience with complex insurance claims, high-dollar denials, and escalation strategies to obtain payment.
• Experience in EMR systems such as Epic, Cerner, Allscripts, Nextgen, or comparable platforms is required.

Knowledge, Skills, and Abilities
• Knowledge of ICD-10 Diagnosis and procedure codes, CPT/HCPCS codes, and advanced claim processing requirements.
• Knowledge of rules and regulations relative to Healthcare Revenue Cycle management.
• Skilled in the investigation and resolution of complex, escalated claims, particularly those requiring advanced appeal processes.
• Skilled in identifying, researching, and implementing new rules and regulations to remain current in revenue cycle management.
• Skilled in validating payments and identifying discrepancies with minimal oversight.
• Skilled with computers, including Microsoft Office Suite/Teams, GoToMeeting/Zoom, etc.
• Ability to make strategic decisions and lead initiatives to improve claim resolution processes.
• Ability to maintain a positive outlook, a pleasant demeanor, and act in the best interest of the organization and the client.
• Ability of professional accountability for quality and timeliness of high-complexity work.
• Ability to draft appeals that are direct, evidence-based, and that precisely address the denial reason.