State Licensed Account Resolution Specialist

Job Summary

Managing high-dollar and complex insurance accounts, the fully remote State Licensed Account Resolution Specialist will resolve escalated claims, submit accurate medical claims, and ensure compliance with payer requirements while achieving productivity and quality goals.

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 managing complex claims
• Advanced knowledge of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations
• Experience using EHR/EMR systems such as Meditech, Epic, or Cerner