Account Resolution Specialist - Insurance HMOs - Digitech - Remote

The Sarnova Family of companies includes Digitech Computer, Bound Tree Medical, Tri-anim Health Services, Cardio Partners, and Emergency Medical Products
 
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: Digitech is seeking a highly motivated and detail‑oriented Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to Medicare HMOs, Medicaid MCOs, and Facilities. This role is responsible for ensuring timely, accurate, and compliant claim resolution by reviewing pending, denied, or incorrectly paid claims and following through until payment is secured. Success in this role requires strong analytical skills, excellent follow‑through, and the ability to manage a high‑volume workload in a fast‑paced environment.

 
This is a remote, work‑from‑home position, operating Monday through Friday during standard business hours, aligned with the team’s 8:00am–4:30pm Eastern Time schedule.
 
Essential Duties and Responsibilities:  

Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by Medicare HMOs, Medicaid MCOs, and Facilities
Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow‑up actions to release claims for processing
Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmissions
Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims
Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing
Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer‑specific requirements
Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds
Maintain accurate, detailed notes in billing systems for all follow‑up activities, findings, and next steps
Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement
Meet daily productivity and accuracy expectations, contributing to a high‑performing team environment
Additional job duties as assigned

 
Skills/Experience Required:  

Education: High School Diploma or equivalent required
Strong computer skills, including working knowledge of MS Outlook, Word, and Excel
Ability to type 40 WPM with accuracy
Proven ability to handle high‑volume workloads, prioritize effectively, and meet tight deadlines
Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful
Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers
Excellent written communication skills for crafting clear, accurate documentation and correspondence
Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings
Highly organized, self‑paced, and capable of managing work independently in a remote environment
Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed
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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