Account Resolution Specialist III - HB/PB

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.