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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing healthcare insurance claims, including appeals and account resolution, while ensuring compliance with payer-specific requirements and regulations. Proficient in utilizing EMR/EHR systems and maintaining high productivity and quality assurance standards.
Highest-signal resume keywords
Medical Claims ManagementICD-10 KnowledgeClaim Denial AppealsEMR/EHR Systems ProficiencyHealthcare Revenue Cycle Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingAccount ManagementClaim Follow-UpCoding PrinciplesPayer GuidelinesPayment ValidationClaims InvestigationError CorrectionAppeal PreparationRevenue Cycle Process
Soft Skills
Strong Communication SkillsDecision-Making AbilityAdvocacy SkillsIndependent Work CapabilityProblem-Solving Skills
Tools & Technologies
Microsoft Office SuiteTeamsMeditechEpicCernerAllscriptsNextGen
Industry Keywords
Healthcare ClaimsMedicareMedicaidWorkers' CompensationCommercial Health PlansPayer-Specific RequirementsQuality AssuranceProductivity Goals
About the role
Key responsibilities & impact- Manage insurance claims for healthcare clients, ensuring accurate and timely payment processing
- Handle claim denials, appeals, account follow-up, collections, self-pay account resolution, customer service, and overall account management
- Manage accounts receivable from claim billing through final resolution
- Support government or commercial payer portfolios, including Medicare, Medicaid, Medicare Advantage, Veterans Affairs, Workers' Compensation, and commercial health plans
- Submit medical claims according to federal, state, and payer-specific requirements
- Review and correct claim edits, errors, and denials
- Investigate and analyze claim errors and rejections and apply necessary corrections
- Follow up with payers and collect assigned insurance accounts receivable
- Monitor payer updates and process changes
- Evaluate non-payment reasons and resolve claims
- Prepare and submit first- and second-level appeals with supporting documentation
- Identify and document coding, clinical, and registration issues for referral to appropriate teams
- Escalate stalled claims to payers or Currance leadership
- Verify and adjust claims to ensure correct client account liabilities and balances
- Communicate payer-specific issues to the team and manager
- Perform other duties assigned to support business needs
- Achieve 100% of the project daily productivity goal and 90% monthly quality assurance score
Requirements
What you’ll need- High school diploma or equivalent
- Minimum 2 years of experience securing medical claim payments from health insurance companies
- Experience managing claim follow-up and appealing denied claims with healthcare vendors or providers
- Experience using EMR/EHR systems such as Meditech, Epic, Cerner, Allscripts, NextGen, or similar platforms
- Strong working knowledge of ICD-10, CPT/HCPCS, payer guidelines, and the revenue cycle process
- Strong written and verbal communication skills, with ability to advocate effectively with payers
- Proficiency in Microsoft Office Suite, Teams, and various desktop applications
- Knowledge of basic coding principles and payer-specific billing requirements
- Knowledge of regulations and rules related to Healthcare Revenue Cycle administration
- Skilled in investigating medical accounts
- Ability to validate payments
- Ability to make decisions and take action
- Ability to quickly learn and use collaboration and messaging tools
- Ability to work independently and achieve results with minimal oversight
- Must meet productivity goal of 100% of the project daily goal
- Must meet quality goal of 90% monthly quality assurance score
- Candidates are subject to criminal background, employment verification, and government exclusion checks as a condition of employment or engagement
Benefits
Comp & perks- Remote position
- Team coverage hours typically 7:30 AM to 7:30 PM CST
- Criminal background check, employment verification check, and mandatory government exclusion check conducted as part of the hiring process