Account Resolution Specialist

Prime Healthcare; Chicago (IL); On-site; USD 25,000 - 36,000; Full time

Benefits offered by this job

401K retirement plan

Medical, dental, and vision coverage

Paid time off

Tuition reimbursement

Job summary

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer interactions. You will communicate with health plans by phone, review denied claims, and support timely collections while ensuring compliance and accurate documentation.

Ideal candidates have 4+ years in medical billing, strong analytical abilities, and proficiency with EHRs (preferably Epic).

Qualifications

• 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).

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 upscale 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 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

Skills

Analytical skills

Problem-solving abilities

Effective communication

Interpersonal skills

Microsoft Office proficiency

Tools

Epic

Microsoft Excel

Job description

Overview

• Department: Administration
• Schedule: Monday-Friday 8:00am-4:30pm
• Facility: Prime Healthcare Medical Group
• Location: Chicago IL

Responsibilities

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.

Essential Duties and 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 upscale 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

Qualifications

EDUCATION, EXPERIENCE, TRAINING

• 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)

Pay Transparency

Prime Healthcare Illinois Medical Group offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $18.00 to $26.07. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

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Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf