State Licensed Account Resolution Specialist

Job Summary

Managing complex, high-dollar insurance accounts, the fully remote State Licensed Account Resolution Specialist will resolve denials, submit claims, and ensure compliance with payer regulations while meeting productivity and quality goals.

Key responsibilities

• Independently manage high-volume accounts with significant financial impact
• Submit accurate medical claims and resolve multi-level denials through advanced research and follow-up
• Prepare and submit appeals with supporting documentation, ensuring thorough tracking 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 denials
• Advanced knowledge of ICD-10, CPT/HCPCS, and payer policies
• Experience using EHR/EMR systems such as Epic, Cerner, or Meditech