Account Resolution Specialist III

This is a fully remote position, open to applicants in Arizona, +22 more locations.

📋 Description

• Manage complex hospital billing accounts that involve high dollar amounts and high volumes independently.

• Ensure the submission of precise medical claims that adhere to federal, state, and payer-specific regulations.

• Address multi-level denials through in-depth research, escalation with the payer, and thorough follow-up.

• Conduct investigations and follow up with payers to recover accounts receivables for insurance.

• Prepare and submit first- and second-level appeals along with comprehensive supporting documentation.

• Implement and oversee EHR workflows in systems such as Epic, Cerner, Meditech, and Allscripts, handling reroutes, denial closures, and account adjustments.

• Analyze Explanation of Benefits (EOBs) to rectify payment discrepancies, claim denials, and contractual underpayments.

• Process rebills and corrections to optimize reimbursement outcomes.

• Examine payment discrepancies and execute necessary corrective measures.

• Achieve productivity and quality targets: 125% of daily project goals and a 95% quality assurance score monthly.

• Investigate, analyze, and rectify errors and rejections; determine root causes and implement preventive measures.

• Verify and modify claims to ensure accurate client liability and account balances.

• Remain updated on changes to payer guidelines and processes.

• Recognize payer trends that influence reimbursement and communicate findings to management.

• Engage in daily shift briefings and contribute as necessary.

• Provide support in an Acute Hospital client environment utilizing Epic, Artiva, and payer portals including Availity.

⛳️ Requirements

• A high school diploma or equivalent is required.

• An Associate's degree is preferred.

• CRCR certification or completion of certification must be achieved within 90 days of hire.

• At least 3 years of experience in obtaining medical claim payments, managing follow-up, and appealing denials, demonstrating success in resolving complex, high-value claims.

• Advanced understanding of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations.

• Strong skills in negotiation, research, and problem-solving.

• Experience with EHR/EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms to facilitate billing and account resolution.

• Proficient in Microsoft Office Suite, Teams, and various desktop applications.

• Familiarity with ICD-10 diagnosis and procedure codes as well as CPT/HCPCS codes.

• Knowledge of rules and regulations pertaining to Healthcare Revenue Cycle administration.

• Capable of validating payments, making informed decisions, utilizing collaboration tools, researching healthcare revenue cycle rules and regulations, and taking professional ownership for quality and timeliness.

🏝️ Benefits

• Competitive salary and compensation package.

• Opportunities for professional development and growth.

• Comprehensive health and wellness benefits.

• Supportive and collaborative work environment.