Account Resolution Specialist III

This is a fully remote position, open to applicants in Arizona, +21 more states.

📋 Description

• Manage complex accounts independently that involve significant financial implications, with a focus on high-dollar and high-volume transactions.

• Accurately submit medical claims while adhering to federal, state, and payer-specific regulations.

• Tackle multi-level denials through comprehensive research, escalation with payers, and meticulous follow-up.

• Conduct investigations and pursue payers to recover accounts receivable for insurance.

• Prepare and file first- and second-level appeals, ensuring complete supporting documentation and diligent tracking to enhance reimbursement potential.

• Implement and oversee EHR workflows, including reroutes, denial resolutions, and account adjustments.

• Examine EOBs to rectify payment variances, claim denials, and contractual underpayments.

• Complete rebilling and corrections to optimize reimbursement efforts.

• Analyze payment inconsistencies and initiate corrective measures.

• Achieve productivity and quality targets consistently.

• Investigate, analyze, and rectify errors and rejections; identify root causes and propose preventive measures.

• Validate and amend claims to guarantee precise client liabilities and account balances.

• Stay updated on changes in payer guidelines and processes.

• Recognize payer trends affecting reimbursement and present findings to management.

• Engage in daily shift briefings.

• Attain 125% of the daily productivity target for the project and maintain a 95% monthly quality assurance score.

⛳️ Requirements

• A high school diploma or equivalent is mandatory.

• An associate's degree is preferred.

• CRCR certification or completion of the certification is required within 90 days of hiring.

• A minimum of 3 years of experience in securing medical claim payments, managing follow-ups, and appealing denials, demonstrating successful resolution of 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 the Microsoft Office Suite, Teams, and various desktop applications.

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

• Knowledge of regulations relating to Healthcare Revenue Cycle administration.

• Capability to validate payments, make informed decisions, learn and utilize collaboration tools and messaging systems, and research healthcare revenue cycle rules and regulations.

• A criminal background check, employment verification check, and government exclusion check are required as conditions of employment or engagement.

🏝️ Benefits

• Competitive salary and performance bonuses.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Ongoing professional development and training opportunities.

• Flexible working hours and remote work options.