State Licensed Account Resolution Specialist

Job Summary

A company is looking for an Account Resolution Specialist III to manage complex insurance accounts and ensure timely claim resolution.

Key Responsibilities

• Independently manage high-dollar and complex accounts, ensuring accurate claim submissions and resolution of denials
• Prepare and submit appeals with supporting documentation while analyzing payment discrepancies and implementing corrective actions
• Meet productivity and quality benchmarks while staying informed about payer guidelines and trends impacting 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 follow-up
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Meditech, Epic, Cerner, or similar platforms