Account Resolution Specialist

Job Summary

Independently managing high-dollar and complex accounts, the fully remote Account Resolution Specialist III will resolve escalated insurance claims, submit accurate medical claims, and ensure compliance with payer guidelines while achieving productivity and quality goals.

Key responsibilities:

• Independently manage high-dollar, high volume, and complex accounts with significant financial impact
• Resolve multi-level denials that require advanced research, payer escalation, and detailed follow-up
• Analyze discrepancies in payments and take corrective actions as needed to maximize reimbursement

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 follow-up
• Advanced knowledge of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations
• Experience using EHR/EMR systems such as Meditech, Epic, Cerner, or similar platforms