Role Description The Medicare Account Resolution Specialist is responsible for managing and resolving Medicare claims after submission to ensure accurate and timely processing. This role requires strong analytical skills, exceptional attention to detail, and the ability to manage multiple tasks in a fast-paced billing environment. The ideal candidate is thorough, dependable, and skilled at navigating Medicare guidelines, denials, and follow-up processes.

• Work Medicare claims that are pending, unable to be released, denied, or paid incorrectly, ensuring each claim is resolved appropriately and returned to payment status.
• Review and resolve claims placed on hold by identifying the reason for the hold, correcting errors, and completing all required follow-up actions.
• Analyze Medicare denials to determine accuracy, identify next steps, and complete appeals, adjustments, or resubmissions as needed.
• Provide Medicare with any additional documentation or information necessary for accurate claim adjudication.
• Prepare, process, and track correspondence such as letters, emails, supporting documents, and required refunds.
• Maintain detailed and accurate notes, documentation, and workflow updates within billing systems to support claim progression and audit requirements.
• Additional job duties as assigned.

Qualifications

• High School Diploma or equivalent required.
• Strong computer skills with working knowledge of MS Outlook, Word, and Excel.
• Ability to type a minimum of 40 WPM with accuracy.
• Proven ability to manage high-volume workloads while meeting strict deadlines.
• Experience in an environment with call monitoring, productivity metrics, or performance scoring is preferred.
• Ability to remain calm, professional, and effective during phone interactions while maintaining a positive company image.
• Excellent written and verbal communication skills, with the ability to explain information clearly and professionally.
• High attention to detail with strong accuracy in claim review and documentation.
• Strong organizational and time-management skills with the ability to prioritize work and complete assigned tasks efficiently.
• Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment.

Requirements

• Ability to talk, hear, and see clearly to read and interpret information.
• Regular use of a computer, phone, and standard office equipment.
• Ability to secure confidential information.
• Perform all duties in a professional environment free of noise or anything that would create a negative customer experience.

Benefits

• Competitive salary, commensurate with experience.
• Comprehensive benefits package, including 401(k) Plan.