Healthcare Account Resolution Specialist

Job Summary

A company is looking for an Account Resolution Specialist III responsible for managing complex insurance accounts and ensuring timely claim resolution.

Key Responsibilities

• Independently manage high-dollar, high-volume, and complex accounts with significant financial impact
• Submit accurate medical claims in compliance with federal, state, and payer-specific requirements
• Resolve multi-level denials requiring advanced research, payer escalation, and detailed follow-up

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