Acct Res
Located in Mobile, AL
Job Full Description
Job Title: Account Resolution Specialist
Position Summary:
The Account Resolution Specialist is responsible for ensuring accurate and timely submission of medical claims and resolving issues that prevent payment. This role involves analyzing claim errors, following up with payers, and preparing appeals to secure reimbursement. The specialist serves as a key contributor to the revenue cycle team by identifying trends, escalating issues, and collaborating across departments to improve claim outcomes.
Key Responsibilities:
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Claims Submission & Review:
- Submit medical claims in compliance with federal, state, and payer-specific requirements.
- Review and correct edits, errors, and denials to ensure claims are properly submitted and paid.
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Error Investigation & Correction:
- Analyze claim rejections and errors to apply necessary corrections.
- Evaluate reasons for non-payment and take appropriate action to resolve claims.
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Follow-Up & Collections:
- Follow up with payers to collect assigned insurance accounts receivable.
- Escalate stalled claims to payers or leadership as needed.
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Appeals & Documentation:
- Prepare and submit first- and second-level appeals with supporting documentation in accordance with payer guidelines and timelines.
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Issue Identification & Communication:
- Identify and document coding, clinical, and registration issues for referral to appropriate teams.
- Communicate payer-specific issues to the team and manager to support process improvement.
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Account Accuracy:
- Verify and adjust claims to ensure client accounts reflect correct liability and balances.
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Regulatory Awareness:
- Stay informed about payer updates and process changes to ensure accurate claims submission and follow-up.
Qualifications:
- High school diploma or equivalent; associate degree or certification in medical billing or healthcare administration preferred.
- 2+ years of experience in medical billing, claims resolution, or healthcare revenue cycle.
- Strong understanding of insurance guidelines, medical coding, and claims processing.
- Excellent analytical, problem-solving, and communication skills.
- Proficiency in billing software and Microsoft Office Suite.
- Ability to work independently and collaboratively in a fast-paced environment.
Mobile, AL
2327
3662 Dauphin Street
Suite B
Mobile, AL 36608
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