Account Resolution Specialist - Insurance HMOs - Digitech - Remote

Digitech; United States; On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

401(k) Plan

Job summary

Digitech is seeking a highly motivated Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to Medicare HMOs, Medicaid MCOs, and Facilities. This remote, work-from-home role requires accuracy, analytical skills, and the ability to handle a high-volume workload.

The position operates Monday through Friday during standard business hours, aligned with Eastern Time, and offers a comprehensive benefits package and competitive compensation.

Qualifications

• Education: High School Diploma or equivalent required.
• Strong computer skills including MS Outlook, Word, Excel.
• Ability to type 40 WPM with accuracy.
• Proven ability to handle high-volume workloads and meet deadlines.
• Experience in a structured environment with call monitoring or productivity metrics is helpful.
• Strong verbal and written communication for documentation and correspondence.
• Highly organized and able to work independently in a remote environment.

Responsibilities

• Research and resolve outstanding insurance claims from Medicare HMOs, Medicaid MCOs, and facilities.
• Investigate claims on hold, identify root causes, correct errors and follow up to release.
• Analyze denials, determine reasons, and pursue resolutions such as appeals or resubmissions.
• Communicate with insurance carriers to obtain status and clarify discrepancies.
• Prepare and submit documentation requested by carriers to support adjudication.
• Draft and submit appeals with proper documentation and guidelines.
• Process incoming correspondence and refunds as needed.
• Maintain detailed notes in billing systems for follow-up actions.
• Identify trends and escalate to improve processes.
• Meet daily productivity and accuracy targets.

Skills

Communication

Time management

Attention to detail

Remote work capable

Typing 40 WPM

Education

High School Diploma or equivalent

Tools

MS Outlook

MS Word

MS Excel

Job description

The Sarnova Family of companies includes Digitech Computer, Bound Tree Medical, Tri-anim Health Services, Cardio Partners, and Emergency Medical Products.

Digitech is a leading provider of advanced billing and technology services to the EMS transport industry. Since its founding in 1984, Digitech has refined its software platform to create a cloud-based billing and business intelligence solution that monitors and automates the entire EMS revenue lifecycle. Digitech leverages its proprietary technology to offer fully outsourced services that maximize collections, protect compliance, and deliver results for clients.

Summary

Digitech is seeking a highly motivated and detail-oriented Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to Medicare HMOs, Medicaid MCOs, and Facilities. This role is responsible for ensuring timely, accurate, and compliant claim resolution by reviewing pending, denied, or incorrectly paid claims and following through until payment is secured. Success in this role requires strong analytical skills, excellent follow-through, and the ability to manage a high-volume workload in a fast-paced environment.

This is a remote, work-from-home position, operating Monday through Friday during standard business hours, aligned with the team’s 8:00am-4:30pm Eastern Time schedule.

Essential Duties And Responsibilities

• Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by Medicare HMOs, Medicaid MCOs, and Facilities
• Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow‑up actions to release claims for processing
• Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmissions
• Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims
• Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing
• Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer‑specific requirements
• Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds
• Maintain accurate, detailed notes in billing systems for all follow‑up activities, findings, and next steps
• Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement
• Meet daily productivity and accuracy expectations, contributing to a high‑performing team environment
• Additional job duties as assigned

Skills/Experience Required

• Education: High School Diploma or equivalent required
• Strong computer skills, including working knowledge of MS Outlook, Word, and Excel
• Ability to type 40 WPM with accuracy
• Proven ability to handle high-volume workloads, prioritize effectively, and meet tight deadlines
• Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful
• Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers
• Excellent written communication skills for crafting clear, accurate documentation and correspondence
• Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings
• Highly organized, self‑paced, and capable of managing work independently in a remote environment
• Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed
• Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment

Sarnova is an Equal Opportunity Employer. We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EO/M/F/Veterans/Disabled.

Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity.

#digitech