[Hiring] Medicaid Account Resolution Specialist @Sarnova

Role Description

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.

• 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.

Qualifications

• 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.

Benefits

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