Remote Medicaid Claims Resolution Specialist

Tri-anim Health Services, Inc.; Northern (KY); Hybrid; USD 45,000 - 60,000; Full time

Job summary

Digitech is seeking a Medicaid Account Resolution Specialist to resolve Medicaid claims after submission, ensuring accurate reimbursement and timely follow‑up. The role requires meticulous attention to detail, the ability to manage multiple priorities, and commitment to high‑quality service for clients and patients.

Responsibilities include reviewing pending/denied claims, identifying hold reasons, submitting documentation or appeals, and maintaining detailed records in the billing system while

Qualifications

• High School Diploma or equivalent.
• Proficient in MS Outlook, Word and Excel.
• Typing speed of 40 WPM.
• Ability to manage a high volume of work and meet deadlines.
• Experience in metrics-driven environments is helpful.

Responsibilities

• Review Medicaid claims pending, on hold, denied, or paid incorrectly and take steps to secure reimbursement.
• Identify hold reasons by reviewing account details and ensuring information is complete and compliant with Medicaid guidelines.
• Evaluate denial reasons and complete timely follow-up to move claims toward payment.
• Submit documentation to Medicaid including adjustments, corrections, and appeals when needed.
• Monitor correspondence and process refunds or adjustments as required.
• Document all actions on each claim in the billing system for compliance.
• Recognize trends and alert management to potential impact on timelines.
• Maintain productivity and quality while meeting timelines and filing limits.
• Additional duties as assigned.

Skills

Multitasking

Communication

Attention to detail

Remote work

Typing 40 WPM

Education

High School Diploma or equivalent

Tools

MS Outlook

MS Word

MS Excel

Job description

Digitech is seeking a Medicaid Account Resolution Specialist to resolve Medicaid claims after submission, ensuring accurate reimbursement and timely follow‑up. The role requires meticulous attention to detail, the ability to manage multiple priorities, and commitment to high‑quality service for clients and patients.

Responsibilities include reviewing pending/denied claims, identifying hold reasons, submitting documentation or appeals, and maintaining detailed records in the billing system while