Account Resolution Specialist III

This is a fully remote position, open to applicants in Arizona, +20 more states.

📋 Description

• Manage complex accounts that are high-dollar and high-volume independently.

• Accurately submit medical claims in compliance with federal, state, and payer-specific regulations.

• Address multi-level denials through detailed follow-up, advanced research, and payer escalation.

• Investigate payers and collect on insurance accounts receivable.

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

• Oversee and execute EHR workflows in platforms like Epic, Cerner, Meditech, and Allscripts, including reroutes, denial closures, and adjustments to accounts.

• Review Explanation of Benefits (EOBs) to resolve payment discrepancies, denials, and contractual underpayments.

• Process rebills and corrections to optimize reimbursement.

• Analyze payment discrepancies and implement corrective actions.

• Meet established productivity and quality benchmarks.

• Research and rectify errors and rejections, identifying root causes and instituting preventive measures.

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

• Stay updated on changes in payer guidelines and processes.

• Identify trends among payers that impact reimbursement and report findings to management.

• Participate in daily shift briefings.

• Achieve 125% of the project's daily goal and maintain a 95% monthly quality assurance score.

⛳️ 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.

• A minimum of 3 years of experience in securing payments for medical claims, managing follow-up, and appealing denials is necessary.

• Proven track record of successfully 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.

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

• Knowledgeable about healthcare revenue cycle administration rules and regulations.

• Ability to validate payments, make informed decisions, research healthcare revenue cycle laws, and maintain the quality and timeliness of work.

• Candidates residing in MST, CST, or PST time zones are preferred.

🏝️ Benefits

• Completion of CRCR certification is required within 90 days of hire.

• Background checks, employment verification, and government exclusion checks will be conducted as part of the hiring process.