Denial Resolution Specialist

🔥 0 minutes ago

🌵 Arizona, California, +18 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $21 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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Currance

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2020

🤝 B2B

🏢 Enterprise

B2B • Enterprise

Currance is a healthcare-focused revenue cycle management company that partners with hospitals, health systems, and physician groups to streamline billing, collections, and administrative workflows. They provide customizable, technology-enabled and hybrid solutions—insurance resolution, insurance management, and outsourced business office services—to accelerate cash collections, reduce accounts receivable days, and improve yield. Currance operates as a B2B service provider delivering consultative, performance-driven revenue cycle improvements across large and community healthcare organizations.

📋 Description

• Execute tasks focused on revenue generation through account resolution for any company client. • Review documentation to support or contest payer coding decisions for multiple facilities. • Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable. • Investigate the root causes of denials and downgrades, as needed. • Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues. • Participate in daily shift briefings and contribute actively. • Resubmit corrected claims according to Federal, State, and payer-mandated guidelines. • Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors. • Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client. • Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements. • Meet productivity standards while maintaining quality output. • Communicate payer-specific issues to the team and management for timely resolution. • Engage in continuous learning to remain up to date on coding and payer policies.

🎯 Requirements

• High school diploma or equivalent (GED) required. • Associate or bachelor’s degree in healthcare management, Health Information Management/Technology (HIM/HIT) preferred. • Current/active CCS or CPC certification required • Minimum of 3 years’ experience resolving payer denials and/or conducting coding audits. • At least 3 years’ experience in medical claim payments, follow-up, and appealing denials, with proven success resolving complex, high-value claims. • Advanced knowledge of ICD-10, CPT/HCPCS, NCCI edits, DRG/APC assignment, payer policies, and reimbursement regulations. • Strong negotiation, research, written communication, and problem-solving skills, with the ability defend coding-related positions. • Experience correcting and resubmitting denied claims due to coding issues, including modifiers, revenue codes, bundling, and NPI discrepancies. • Ability to research regulatory references (CMS, Medicaid, LCD/NCD guidelines) and apply them to appeals. • Demonstrated ability to analyze denial trends and recommend process or coding improvements. • Familiarity with compliance standards (OIG, CMS, HIPAA) related to coding and billing. • Experience using EHR/EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms for billing and account resolution. • Ability to collaborate effectively with other coders, clinicians, and account resolution specialists to resolve complex coding and reimbursement issues. • Proficiency in Microsoft Office Suite, Teams, and various desktop applications.