About The Position
The Medicaid Account Resolution Specialist is responsible for resolving Medicaid claims after submission, ensuring accurate reimbursement and timely follow‑up throughout the billing lifecycle. This role requires strong attention to detail, consistent follow‑through, the ability to manage multiple priorities, and a commitment to delivering high‑quality service to both clients and patients.
Requirements
- High School Diploma or equivalent
- Strong computer proficiency, including MS Outlook, Word, and Excel
- Ability to multi‑task effectively in a fast‑paced environment
- Minimum typing speed of 40 WPM with accuracy
- Proven ability to manage a high volume of work while meeting strict deadlines
- Ability to remain calm, professional, and solution‑oriented during phone interactions while representing the company positively
- Excellent written and verbal communication skills; able to clearly present information and resolve issues
- High attention to detail with strong accuracy and follow‑through
- Ability to organize, prioritize, and manage workload independently
- Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment
Nice To Haves
- Experience working in metrics‑driven environments—such as call centers or performance‑based roles—is helpful
Responsibilities
- Review Medicaid claims that are pending, on hold, denied, or paid incorrectly, and take appropriate steps to resolve issues and secure accurate reimbursement
- Identify the reasons claims are on hold by reviewing account details, correcting errors, and ensuring all required information is complete and compliant with Medicaid guidelines
- Evaluate denial reasons, determine the next steps for correction or resubmission, and complete timely follow‑up to move claims toward payment
- Submit additional documentation or clarification to Medicaid as needed, including adjustments, corrections, and appeal requests when claims require further review
- Monitor and manage incoming correspondence—mail, email, and electronic notifications—responding promptly and processing refunds or adjustments when required
- Document all actions taken on each claim in the billing system to maintain accurate records and support compliance with payer and internal requirements
- Recognize recurring issues or trends (such as missing information or common denial codes) and alert management when patterns may impact claim processing or reimbursement timelines
- Maintain productivity and quality standards while managing a high volume of claims and meeting required timelines and filing limits
- Additional job duties as assigned
Benefits
- 401(k) Plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
