Managing high-dollar and complex insurance accounts, the fully remote State Licensed Account Resolution Specialist will resolve escalated claims, submit accurate medical claims, and ensure compliance with payer requirements while meeting productivity and quality goals. Key responsibilities Independently manage complex accounts with significant financial impact, ensuring timely resolution and payment processing Submit accurate medical claims and prepare first- and second-level appeals with thorough documentation Analyze payment discrepancies and implement corrective actions while maintaining high productivity and quality standards Required qualifications High school diploma or equivalent required; Associate's degree preferred CRCR certification or completion of certification required within 90 days of hire Minimum 3 years of experience in securing medical claim payments and managing follow-up for complex claims Advanced knowledge of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations Experience using EHR/EMR systems such as Meditech, Epic, Cerner, or Allscripts
State Licensed Account Resolution Specialist • Corona, California, United States
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