Account Resolution Specialist

Saint Michael's Medical Center; Chicago (IL); On-site; USD 25,000 - 36,000; Full time

Job summary

Prime Healthcare Illinois Medical Group in Chicago is seeking an Account Resolution Specialist to ensure timely follow-up with managed care and government payers by phone, review payer contracts, and uphold productive billing operations.

You will work with revenue, coding and billing teams to resolve denials, prepare appeal letters, and monitor KPIs while ensuring compliance with Medicaid regulations and accurate patient financial records.

Qualifications

• Minimum of 4 years of experience in Medicaid billing and follow-up.
• In-depth knowledge of Medicaid regulations, coding, and billing procedures.
• Experience with Medicaid 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

• Follow up on A/R to identify and resolve payer issues.
• Follow up on unpaid claims to work toward resolution and collection.
• Address and resolve denials using medical records and payer contracts.
• Compose and submit appeal letters.
• Identify and elevate denial patterns to leadership.
• Coordinate with revenue, coding and billing teams to resolve issues.
• Achieve established KPIs.
• Understand Medicaid regulations and IDHS MEDI system.
• Adhere to billing and compliance guidelines and maintain records.

Skills

Analytical thinking

Attention to detail

Communication skills

Independent work

Education

4+ years Medicaid billing experience

Tools

Epic EHR

Billing software

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