Account Resolution Specialist

Prime Healthcare • Chicago, IL

9d • Onsite

About The Position

The Account Resolution Specialist is responsible for the timely follow-up of Managed Care and Government payers. Communicates clearly and efficiently by phone with health plans. Maintains productivity standards and reports. Responsible to obtain State collection guidelines if applicable. Reviews managed care contracts.

Requirements

• Minimum of 4 years of experience in medical billing, with a focus on Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with medical billing software and electronic health records (EHR) systems, preferably Epic.
• 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 (Word, Excel).

Nice To Haves

• Experience with IDHS MEDI system

Responsibilities

• Responsible for A/R follow up to identify and resolve payer no response and denial issues.
• Follow up on unpaid claims to work towards resolution and collection on outstanding balances.
• Address and resolve denials received from Payers through the review of medical records and payer contracts, while prioritizing high dollars and aged claims.
• Ability to compose and submit appeal letters and represent a compelling case to overturn denials with payers.
• Identify and escalate denial patterns to leadership in a timely manner.
• Partner with operational and clinic leadership to identify processes leading to payer denial.
• Coordinate with revenue, coding and billing departments to resolve project issues.
• Achieve established key performance indicators (KPIs).
• Possesses an understanding of Medicaid and Medicaid Managed Care regulations and billing guidelines.
• Experience with IDHS MEDI system.
• Adhere to all billing and compliance regulatory guidelines, while maintaining detailed and accurate patient financial records and documentation.

Benefits

• paid time off
• a 401K retirement plan
• medical, dental, and vision coverage
• tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed