Account Resolution Specialist

Job Summary

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

Key responsibilities

• Independently manage high-dollar, high-volume accounts with significant financial impact
• Resolve multi-level denials through advanced research, payer escalation, and detailed follow-up
• Prepare and submit appeals with complete documentation 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 appeals
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Meditech, Epic, or Cerner