Medicaid Account Resolution Specialist - Digitech - Remote

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

Skills/Experience Required

• Education: High School Diploma or equivalent required
• Strong computer skills, including working knowledge of 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
• Able to organize, prioritize, and manage workload independently
• Able to independently manage all aspects of the job role including required goals and business practices in a remote environment

Physical 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

Work environment characteristics

• 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

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

Pay

Competitive salary, commensurate with experience

Schedule

Remote work environment