Medicare Account Resolution Specialist - Digitech - Remote

Sarnova

14d•Remote

About The Position

The Medicare Account Resolution Specialist manages and resolves Medicare claims after submission to ensure accurate and timely processing. The role involves reviewing claims that are pending, unable to be released, denied, paid incorrectly, or placed on hold, and completing the actions needed to return them to payment status. The specialist analyzes denials, handles appeals, adjustments, or resubmissions, and provides Medicare with documentation needed for claim adjudication. The role also requires preparing and tracking correspondence and refunds, and maintaining accurate notes, documentation, and workflow updates in billing systems to support claim progression and audit requirements. The successful candidate is detail-oriented, dependable, organized, and able to manage multiple tasks and high-volume work in a fast-paced billing environment. This is a remote position requiring independent management of assigned work, goals, and business practices.

Requirements

High school diploma or equivalent.
Strong computer skills, including working knowledge of MS Outlook, Word, and Excel.
Ability to type at least 40 words per minute accurately.
Proven ability to manage high-volume workloads while meeting strict deadlines.
Ability to remain calm, professional, and effective during phone interactions while maintaining a positive company image.
Excellent written and verbal communication skills, including the ability to explain information clearly and professionally.
High attention to detail and strong accuracy in claim review and documentation.
Strong organizational and time-management skills, with the ability to prioritize work and complete assigned tasks efficiently.
Ability to independently manage all aspects of the role, including required goals and business practices, in a remote environment.
Ability to talk, hear, and see clearly to read and interpret information.
Regular use of a computer, phone, and standard office equipment.
Ability to secure confidential information.
Ability to perform duties in a professional environment free of noise or other factors that could create a negative customer experience.

Nice To Haves

Experience in an environment with call monitoring, productivity metrics, or performance scoring.

Responsibilities

Work Medicare claims that are pending, unable to be released, denied, or paid incorrectly, resolving them appropriately and returning them to payment status.
Review claims placed on hold, identify the reason, correct errors, and complete required follow-up actions.
Analyze Medicare denials, determine their accuracy, and complete appeals, adjustments, or resubmissions as needed.
Provide Medicare with additional documentation or information needed for accurate claim adjudication.
Prepare, process, and track correspondence, including letters, emails, supporting documents, and required refunds.
Maintain detailed and accurate notes, documentation, and workflow updates in billing systems to support claim progression and audit requirements.
Perform additional job duties as assigned.