Remote Medicaid Claims Resolution Specialist

Tri-anim Health Services, Inc.; United States; 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

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

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:

The Medicaid Account Resolution Specialist is responsible for resolving Medicaid claims after submission, ensuring accurate reimbursement and timely follow‑up throughout the billing lifecycle. This role requires strong attention to detail, consistent follow‑through, the ability to manage multiple priorities, and a commitment to delivering high‑quality service to both clients and patients.

Essential Duties and Responsibilities:

• Review Medicaid claims that are pending, on hold, denied, or paid incorrectly, and take appropriate steps to resolve issues and secure accurate reimbursement
• Identify the reasons claims are on hold by reviewing account details, correcting errors, and ensuring all required information is complete and compliant with Medicaid guidelines
• Evaluate denial reasons, determine the next steps for correction or resubmission, and complete timely follow‑up to move claims toward payment
• Submit additional documentation or clarification to Medicaid as needed, including adjustments, corrections, and appeal requests when claims require further review
• Monitor and manage incoming correspondence—mail, email, and electronic notifications—responding promptly and processing refunds or adjustments when required
• Document all actions taken on each claim in the billing system to maintain accurate records and support compliance with payer and internal requirements
• Recognize recurring issues or trends (such as missing information or common denial codes) and alert management when patterns may impact claim processing or reimbursement timelines
• Maintain productivity and quality standards while managing a high volume of claims and meeting required timelines and filing limits
• Additional job duties as assigned

Skills/Experience Required:

• Education: High School Diploma or equivalent
• Strong computer proficiency, including MS Outlook, Word, and Excel
• Ability to multi‑task effectively in a fast‑paced environment
• Minimum typing speed of 40 WPM with accuracy
• Proven ability to manage a high volume of work while meeting strict deadlines
• Experience working in metrics‑driven environments—such as call centers or performance‑based roles—is helpful
• Ability to remain calm, professional, and solution‑oriented during phone interactions while representing the company positively
• Excellent written and verbal communication skills; able to clearly present information and resolve issues
• High attention to detail with strong accuracy and follow‑through
• Ability to organize, prioritize, and manage workload independently
• 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.

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