State Licensed 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 and resolve multi-level denials requiring 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 appealing denials
• 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