Certified Account Resolution Specialist

Job Summary

Managing complex, high-dollar insurance accounts, the fully remote Certified Account Resolution Specialist will resolve escalated claims, submit accurate medical claims, and oversee denial management while meeting productivity and quality standards.

Key responsibilities

• Independently manage high-dollar and complex accounts, ensuring timely resolution and follow-up
• Submit accurate medical claims and prepare first- and second-level appeals to maximize reimbursement
• Analyze discrepancies in payments and implement corrective actions based on payer guidelines

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 managing 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