Account Resolution Specialist

Prime Healthcare•Chicago, IL

19h•Onsite

About The Position

The Account Resolution Specialist is responsible for timely follow-up with managed care and government payers, communicating clearly and efficiently with health plans by phone, maintaining productivity standards and reports, obtaining applicable state collection guidelines, and reviewing managed care contracts. The role focuses on resolving unpaid claims, payer nonresponse, and denials while adhering to billing and compliance requirements and maintaining accurate patient financial records and documentation. The position works with operational and clinic leadership, as well as revenue, coding, and billing departments, to identify and address denial-related processes and project issues. It requires knowledge of Medicaid and Medicaid Managed Care regulations and billing guidelines, including experience with the IDHS MEDI system.

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.
Experience with medical billing software and electronic health record (EHR) systems.
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 is preferred.

Responsibilities

Follow up on accounts receivable to identify and resolve payer nonresponse and denial issues.
Follow up on unpaid claims to resolve and collect outstanding balances.
Review medical records and payer contracts to address 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.
Meet established key performance indicators (KPIs).
Maintain productivity standards and reports.
Obtain state collection guidelines when applicable and review managed care contracts.
Follow applicable billing and compliance regulations and maintain detailed, accurate patient financial records and documentation.
Communicate with health plans by phone.