Medicaid Account Resolution Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Medicaid claims specialist resolving pending, denied, and incorrect EMS billing claims for Digitech. Managing documentation, appeals, adjustments, and payer follow-up to secure accurate reimbursement.
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 reasons claims are on hold by reviewing account details, correcting errors, and ensuring required information is complete and compliant with Medicaid guidelines
- Evaluate denial reasons, determine correction or resubmission steps, and complete timely follow-up to move claims toward payment
- Submit documentation or clarification to Medicaid, including adjustments, corrections, and appeal requests
- Monitor and manage incoming mail, email, and electronic notifications
- Respond promptly and process refunds or adjustments when required
- Document all claim actions in the billing system to maintain accurate records and support compliance
- Recognize recurring issues or trends and alert management when patterns may affect claim processing or reimbursement timelines
- Maintain productivity and quality standards while managing a high volume of claims and meeting required timelines and filing limits
- Perform additional duties as assigned
Requirements:
- 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
- 401(k) Plan
Similar Jobs
Senior Oncology Account Specialist, Genitourinary
Senior Oncology Account Specialist promoting Pfizer’s cancer therapies to healthcare providers across Raleigh-Durham. Managing strategic accounts, educating clinicians, and cultivating oncology Key Opinion Leader relationships.
Neurology Account Specialist
Neurology Account Specialist driving RADICAVA sales for Shionogi’s U.S. ALS rare-disease franchise. Managing territory strategy, healthcare-provider engagement, and hospital formulary access.
Neurology Account Specialist
Neurology Account Specialist advancing Shionogi’s RADICAVA ALS treatment through pharmaceutical sales. Building healthcare-provider relationships, territory plans, and product access strategies.
Cardiovascular Account Specialist
Cardiovascular Account Specialist launching Cytokinetics’ novel HCM medicine across a New Jersey territory. Driving biotech sales through hospitals, cardiology clinics, IDNs, and specialty pharmacies.
Revenue Account Specialist
Revenue Account Specialist managing complex medical, dental, vision, and pharmacy billing for Cigna Healthcare clients. Driving collections, reporting, process improvements, and financial risk reduction remotely.
Territory Account Specialist
Territory Account Specialist delivering food safety audits, training, and sanitation equipment services for Solenis. Managing national retail accounts across the San Diego territory.
Loss Control Large Account Technical Specialist
Loss Control Specialist reducing workplace injuries for Zenith workers’ compensation clients. Conducting safety surveys, designing risk controls, and coordinating large-account services across Southern California.
NeuroPsych Account Specialist
Neurocrine Biosciences account specialist promoting neurological and psychiatric medicines across a Vermont territory. Managing healthcare relationships, education, and specialty pharmaceutical sales.
NeuroPsych Account Specialist
Neurocrine Biosciences sales specialist growing neurological and psychiatric products across the Columbus territory. Educating healthcare providers and managing strategic pharmaceutical accounts.
Territory Account Specialist
Territory Account Specialist growing Essity’s incontinence business across Chicago, Milwaukee, Michigan, and surrounding healthcare facilities. Managing prospecting, account relationships, pricing, and distribution partnerships.
Oncology Territory Account Specialist, Solid Tumor
Novartis oncology field sales specialist managing Baltimore-area accounts and HCP relationships. Driving demand, access support, and personalized engagements to improve patient outcomes.
Account Specialist, Anti-Infectives
Account Specialist expanding AbbVie’s anti-infective medicines across Minneapolis healthcare accounts. Building hospital relationships, improving patient access, and achieving territory sales goals.
Account Specialist, Anti Infectives
AbbVie Account Specialist expanding Anti-Infectives access and sales across San Jose healthcare accounts. Building hospital relationships, formulary adoption, and compliant product strategies.
Account Specialist, Dermatology
Account Specialist driving dermatology pharmaceutical sales across South London and South East England for AbbVie. Managing healthcare-professional engagement, territory plans, NHS stakeholders, and brand strategy execution.
Requestor Account Specialist
Requestor Account Specialist helping HealthMark, a healthcare information company, manage bulk medical-record requests. Tracking inventory, fees, reports, statuses, and requester communications.
Account Specialist, Anti Infectives
AbbVie Account Specialist expanding Anti-Infective medicine access and sales across Baltimore East, Maryland, and Delaware healthcare accounts. Building hospital relationships, delivering compliant product presentations, and coordinating patient-focused solutions.
Dermatology Territory Account Specialist
Novartis territory account specialist leading dermatology account engagement, access support, and product demand across New York and New Jersey. Improving patient outcomes through field and remote customer partnerships.
Neuroscience Territory Account Specialist
Novartis Territory Account Specialist driving neuroscience account engagement and sales across Milwaukee and Green Bay. Connecting healthcare providers with access solutions to improve patient outcomes.
Disease Territory Account Specialist
Novartis ultra-rare disease account specialist supporting Cleveland healthcare providers. Orchestrating access, reimbursement, treatment initiation, and patient support across field and home-office teams.
Key Account Specialist – Facial Aesthetics
Key Account Specialist responsible for building strategic relationships in the biotech industry for AbbVie. Focused on sales in facial aesthetics with a strong emphasis on consultative selling in the Indian market.