Healthcare Account Resolution Specialist

Job Summary

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

Key responsibilities:

• Independently manage complex accounts with significant financial impact and resolve multi-level denials
• Submit accurate medical claims and prepare first- and second-level appeals with supporting documentation
• Analyze discrepancies in payments and implement corrective actions 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 for complex claims
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Meditech, Epic, or Cerner