Account Resolution Specialist – Insurance HMOs

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct thorough research and resolve outstanding insurance claims, encompassing pending, unreleased, denied, or incorrectly paid claims from Medicare HMOs, Medicaid MCOs, and Facilities.

• Investigate claims that are on hold, identify their root causes, rectify errors, and perform follow-up actions to facilitate claims processing.

• Analyze insurance denials and execute appeals, corrections, or resubmissions as necessary.

• Engage in communication with insurance carriers through outbound calls to ascertain claim status and address any discrepancies.

• Prepare and submit the documentation requested by insurance carriers efficiently.

• Draft and submit appeals that include the necessary documentation and adhere to payer-specific requirements.

• Manage incoming correspondence, including mail, emails, EOBs, information requests, and refunds.

• Keep accurate notes in billing systems for follow-up activities, findings, and next steps.

• Recognize recurring issues and escalate any concerns to supervisors or internal teams as needed.

• Achieve daily productivity and accuracy benchmarks.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent is required.

• Strong computer proficiency, including familiarity with MS Outlook, Word, and Excel.

• Ability to type at least 40 WPM with accuracy.

• Demonstrated capability to manage high-volume workloads, prioritize tasks effectively, and meet stringent deadlines.

• Experience in an environment with call monitoring, performance metrics, or productivity scoring is advantageous.

• Strong verbal communication skills with the ability to maintain composure, professionalism, and effectiveness during phone interactions with insurance carriers.

• Excellent written communication skills for producing clear and precise documentation and correspondence.

• Exceptional attention to detail and accuracy when reviewing claims, identifying discrepancies, and documenting findings.

• Highly organized, self-directed, and capable of managing work independently in a remote setting.

• Reliable, punctual, and accountable, with a readiness to ask questions and seek clarification as needed.

• Ability to independently oversee all facets of the job role, including achieving required goals and adhering to business practices in a remote environment.

🏝️ Benefits

• Competitive salary, based on experience.

• Comprehensive benefits package.

• 401(k) Plan.

• Remote, work-from-home position.