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, complex accounts and resolve multi-level denials
• Submit accurate medical claims and prepare first- and second-level appeals
• Analyze payment discrepancies 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 medical claim payments and denial management
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Meditech, Epic, or Cerner