Account Resolution Specialist

Job Summary

Managing high-dollar and complex insurance accounts, the fully remote Account Resolution Specialist III will resolve multi-level denials, submit accurate medical claims, and ensure compliance with payer regulations while achieving productivity and quality benchmarks.

Key responsibilities

• Independently manage high-volume accounts with significant financial impact and resolve complex claim issues
• Prepare and submit appeals with supporting documentation, ensuring thorough tracking and follow-up
• Investigate payment discrepancies and collaborate with payers to collect insurance accounts receivables

Required 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 and managing appeals
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Epic or Cerner for billing and account resolution