Account Resolution Specialist III - HB/PB

We are hiring in the following States:
AZ, CA, CO, CT, FL, GA, HI, IL, MA, ME, MN, MO, NV, OK, PA, TN, TX, VA, WA
This is a remote position. Candidates who meet the minimum qualifications will be required to complete a video prescreen to move forward in the hiring process. 

Hourly Rate: $21.00 - $23.50

Benefits: PTO, 401K, medical, dental, vision, life insurance, paid holidays, and more

Job Overview

Ensure continuation of revenue flow by overseeing proper claim submission and payment through review and correction of claim edits, errors and denials. Act as SME for account resolution; to include handling denials, appeals, and account follow-up across various payer types, contributing to the financial success of the healthcare organizations that we support. Work with various client teams.

Job Duties and Responsibilities

• Execute tasks to drive revenue by resolving accounts for company clients.

• Address and resolve escalated or delayed claims. 

• Deliver training and support to ARSI and ARSII staff to enhance quality and productivity. 

• Mentor ARS Is and ARS IIs to elevate their skill levels. 

• Submit claims in accordance with Federal, State, and payer mandated guidelines. 

• Meet productivity standards while upholding high-quality performance. 

• Accountable for researching, analyzing, and reviewing claim errors and rejections, and applying appropriate corrections. 

• Ensure claims submitted to payers are free from controllable errors, preventing returns or denials.

• Maintain required knowledge of payer updates and process modifications to ensure accuracy of claims submissions 

• Investigate, follow up with payers, and collect on insurance accounts receivables. 

• Verify and adjust claims to ensure that client accounts accurately reflect the correct liability and balance. 

• Identify any payer specific issues and communicate to team and manager. 

• Conduct training on operational workflows for new hires. 

• Perform quality audits during training for new hires. 

• Participate and contribute to daily shift briefings. 
• Other duties and responsibilities as assigned to meet Company business needs

Qualifications

• Bachelor’s degree in healthcare management or related field preferred. 

• 3-5 years of experience working with health insurance companies in securing payment for medical claims. 

• 3-5 years of experience working with a vendor or directly with hospitals and physician groups, managing claims follow-up and submitting appeals.

• Experience in one or more EMR systems such as Epic, Cerner, Allscripts, Nextgen, or comparable platforms is required. 

• Proficiency with computers including Microsoft Office Suite/Teams, GoToMeeting/Zoom, etc. 

Knowledge, Skills, and Abilities

• Knowledge of ICD-10 Diagnosis and procedure codes and CPT/HCPCS codes 

• Knowledge of rules and regulations relative to Healthcare Revenue Cycle administration 

• Skilled in medical accounts investigation. 

• Ability to achieve results with little oversight. 

• Skilled in investigating and resolving complex and escalated claims 

• Proficient in researching and identifying new rules and regulations related to revenue cycle management 

• Ability to validate payments 

• Ability to make decisions and act. 

• Ability to maintain a positive outlook, a pleasant demeanor, and act in the best interest of the organization and the client. 

• Ability to take professional responsibility for quality and timeliness of work product.