Resolution Jobs in California (NOW HIRING)

Job Overview: As a healthcare revenue cycle business, we manage insurance claims and oversee timely claim resolution and payment processing for our clients. The Accounts Receivable Specialist III is a senior-level role responsible for resolving the more complex, high-dollar, or escalated insurance accounts. ARS IIIs are recognized for their payer knowledge, accuracy, and ability to consistently deliver exceptional results. ARS IIIs are expected to set the standard for quality, productivity, and professionalism, serving as an example for the rest of the team. This role requires strong analytical skills, expert understanding of payer rules, and the ability to work independently while meeting productivity and quality goals.

Role & Client Focus:

This ARS III role will support a complex hospital client environment requiring strong technical expertise and hands-on execution. The ideal candidate will be comfortable working in settings with:

• Support of Hospital Billing (HB) workflows, including volume management, strategies and accuracy.
• Advanced Hospital Billing (HB) knowledge, including problem-account investigation, payer rejection complexities, trends, portals, etc.
• Daily work within Quadax and Meditech, with an understanding of its claims processes
• Driving timely revenue recovery, ensuring accuracy and compliance and identifying trends within payer, client and regulated guidelines.
• Will need to work CST hours.

Job Duties and Responsibilities:

• Independently manage high-dollar, high volume, and complex accounts with significant financial impact.
• Submit accurate medical claims in compliance with federal, state, and payer-specific requirements.
• Resolve multi-level denials that require advanced research, payer escalation, and detailed follow-up.
• Investigate and follow up with payers to collect insurance accounts receivables.
• Prepare and submit first- and second-level appeals with complete supporting documentation, ensuring thorough tracking and follow-up to maximize reimbursement.
• Execute and oversee EHR workflows in systems such as Epic, Cerner, Meditech, and Allscripts, including reroutes, denial closures, and account adjustments.
• Review Explanation of Benefits (EOBs) to resolve payment discrepancies, claim denials, and contractual underpayments.
• Complete rebills and corrections to maximize reimbursement.
• Transforming revenue cycle differently.
• Improving healthcare together.
• Analyze discrepancies in payments and take corrective actions as needed.
• Meet productivity benchmarks while maintaining high-quality standards.
• Research, analyze, and correct errors and rejections, identify root causes, and implement preventive solutions.
• Verify and adjust claims to ensure accurate client liability and account balance.
• Stay informed about changes in payer guidelines and processes for accurate claim submissions.
• Identify payer trends impacting reimbursement and bring findings to management for review.
• Participate in daily shift briefings and contribute as needed.
• Productivity: Achieve 115% 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
• CRCR certification or completion of certification required within 90 days of hire.
• Minimum 3 years of experience in securing medical claim payments, managing follow-up, and appealing denials, with proven success resolving complex, high-value claims.
• Advanced knowledge of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations.
• Strong negotiation, research, and problem-solving abilities.
• Experience using EHR/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.