Account Resolution Specialist III

Job Summary

Focused on resolving complex accounts for government payers, the full-time remote Account Resolution Specialist III will manage high-dollar insurance claims, submit accurate medical claims, and handle multi-level denials while achieving productivity and quality goals.

Key responsibilities

• Independently manage high-volume, complex accounts with significant financial impact
• Submit accurate medical claims and resolve multi-level denials through advanced research and 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 resolving complex claims
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Epic, Cerner, or Meditech