Account Resolution Specialist

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

Job summary

Prime Healthcare Illinois Medical Group is seeking an Account Resolution Specialist to manage Medicaid billing follow-up and payer communications in a fast-paced setting. The role emphasizes timely A/R actions, denial resolution, and adherence to regulatory guidelines while coordinating with clinics and revenue teams.

The position requires 4+ years in medical billing with Medicaid focus, strong analytical skills, and proficiency in Epic EHR and MS Office.

Qualifications

• Minimum of 4 years of experience in medical billing, focused on Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with medical billing software and 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 review of medical records and payer contracts, prioritizing high-dollar and aged claims.
• Compose and submit appeal letters and present a compelling case to overturn denials with payers.
• Identify and elevate 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.
• Understand Medicaid and Medicaid Managed Care regulations; experience with IDHS MEDI system.
• Adhere to all billing and compliance guidelines while maintaining accurate patient financial records.

Skills

Medicaid billing

Analytical skills

Communication

Multitasking

Microsoft Office

Problem solving

Tools

Epic EHR

Billing software

Microsoft Office

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 elevate 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