Insurance Follow-Up Specialist III

Description: We are hiring in the following states:

AR, AZ, CA, CO, FL, GA, IA, IL, LA, MA, ME, MO, NC, NE, NJ, NV, OK, PA, SD, TN, TX, VA, WA, and WI

This is a remote position.

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.

Job Overview

As a healthcare revenue cycle business, we manage insurance claims and oversee timely claim resolution and payment processing for our clients. This role involves reviewing, correcting, and resolving claim edits, errors, and denials to maintain revenue flow. Acting as a subject matter expert, you will handle denials, appeals, and account follow-up across various payer types, collaborating with client teams to ensure the financial success of the healthcare organizations we support.

Job Duties And Responsibilities

• Submit accurate medical claims following federal, state, and payer-specific guidelines.
• Investigate, follow up with payers, and collect on insurance accounts receivables.
• Execute and manage EPIC system workflows, including reroutes, denial closures, and adjustments to maintain accurate account records.
• Review Explanation of Benefits (EOBs) to identify and address payment discrepancies, claim denials, and contractual underpayments.
• Initiate and track appeals, rebills, and corrections, providing comprehensive documentation to ensure maximum reimbursement.
• Analyze payment discrepancies and implement corrective actions.
• Meet productivity benchmarks while ensuring high-quality performance standards.
• Research, analyze, and correct claim errors and rejections, document root causes, and implement preventative solutions.
• Verify and adjust claims, ensuring accurate client liability and account balances.
• Stay updated on payer guidelines and process modifications for accurate claim submissions.
• Participate and contribute to daily shift briefings.
  
  

Requirements

Qualifications

• Experience with EPIC system preferred.
• High school diploma or equivalent required
• Associate's degree preferred
• 3-5 years of experience working with health insurance companies in securing payment for medical claims.
• 3-5 years of experience with hospital and physician claim follow up and appeals with health insurance companies; commercial and government.
• Proficiency in Microsoft Office Suite, Teams, and virtual meeting platforms (GoToMeeting, Zoom).
• 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.
• 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.
• Ability to achieve results with little oversight.