State Licensed Account Resolution Specialist

Job Summary

A company is looking for an Account Resolution Specialist III, a senior-level role focused on resolving complex insurance accounts.

Key Responsibilities

• Manage high-dollar and complex accounts independently, ensuring timely resolution and payment
• Submit accurate medical claims and resolve multi-level denials through advanced research and follow-up
• 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 securing medical claim payments and managing appeals
• Advanced knowledge of ICD-10, CPT/HCPCS codes, and payer policies
• Experience with EHR/EMR systems and proficiency in Microsoft Office Suite