State Licensed Account Resolution Specialist

Job Summary

To support a high-volume client environment focused on Government payer workflows, the fully remote State Licensed Account Resolution Specialist will manage complex, high-dollar insurance accounts, resolve multi-level denials, and ensure compliance with federal and state regulations.

Key responsibilities:

• Independently manage high-dollar, complex accounts and submit accurate medical claims
• Resolve intricate claim denials through advanced research, payer escalation, and detailed 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 follow-up
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Meditech, Epic, or Cerner