Account Resolution Specialist

Prime Healthcare Illinois Medical Group•Chicago, IL

5d•$18 - $26

About The Position

The Account Resolution Specialist is responsible for timely follow-up with managed care and government payers, including communicating clearly and efficiently with health plans by phone. The role maintains productivity standards and reports, obtains state collection guidelines when applicable, and reviews managed care contracts. It focuses on resolving payer nonresponse and denial issues, following up on unpaid claims, and collecting outstanding balances while ensuring compliance with billing regulations and accurate patient financial documentation.

Requirements

At least 4 years of experience in medical billing, focused on Medicaid billing and follow-up.
In-depth knowledge of Medicaid regulations, coding, and billing procedures.
Understanding of Medicaid and Medicaid Managed Care regulations and billing guidelines.
Experience with the IDHS MEDI system.
Experience with medical billing software and electronic health record (EHR) systems; Epic is preferred.
Strong analytical and problem-solving abilities.
Attention to detail and accuracy.
Effective communication and interpersonal skills.
Ability to work independently and manage multiple tasks.
Proficiency in Microsoft Office Suite, including Word and Excel.

Nice To Haves

Experience with Epic electronic health record systems.

Responsibilities

Conduct accounts receivable follow-up to identify and resolve payer nonresponse and denial issues.
Follow up on unpaid claims to work toward resolution and collection of outstanding balances.
Review medical records and payer contracts to address and resolve payer denials, prioritizing high-dollar and aged claims.
Compose and submit appeal letters and present compelling cases to payers to overturn denials.
Identify denial patterns and escalate them to leadership in a timely manner.
Partner with operational and clinic leadership to identify processes that lead to payer denials.
Coordinate with revenue, coding, and billing departments to resolve project issues.
Achieve established key performance indicators (KPIs).
Obtain state collection guidelines when applicable and review managed care contracts.
Maintain productivity standards and reports.
Adhere to billing and compliance regulatory guidelines while maintaining detailed and accurate patient financial records and documentation.