Medicaid Account Resolution Specialist

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

📋 Description

• Review pending, on hold, denied, or incorrectly paid Medicaid claims, taking necessary actions to resolve issues and ensure accurate reimbursement.

• Identify reasons for claims being on hold by examining account details, rectifying errors, and ensuring that all required information is complete and compliant with Medicaid regulations.

• Assess denial reasons, determine the necessary corrections or resubmission steps, and perform timely follow-ups to advance claims towards payment.

• Submit necessary documentation or clarifications to Medicaid, including adjustments, corrections, and requests for appeals.

• Oversee and manage incoming postal mail, emails, and electronic notifications.

• Respond quickly and process refunds or adjustments as needed.

• Record all actions related to claims in the billing system to uphold accurate records and ensure compliance.

• Identify recurring issues or trends and inform management when such patterns may impact claim processing or reimbursement timelines.

• Maintain productivity and quality standards while handling a high volume of claims and adhering to required timelines and filing deadlines.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• Strong proficiency in computer applications, including MS Outlook, Word, and Excel.

• Capability to effectively multitask in a dynamic work environment.

• Minimum typing speed of 40 WPM with a focus on accuracy.

• Demonstrated ability to manage a substantial workload while adhering to strict deadlines.

• Experience in metric-driven settings—such as call centers or performance-oriented roles—is advantageous.

• Ability to remain composed, professional, and solution-focused during phone interactions while positively representing the company.

• Excellent written and verbal communication skills, able to present information clearly and resolve issues effectively.

• Strong attention to detail with a commitment to accuracy and thorough follow-through.

• Capability to organize, prioritize, and manage workload independently.

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

🏝️ Benefits

• Competitive salary, aligned with experience.

• Comprehensive benefits package.

• 401(k) Plan.