Accounts Receivable Insurance Specialist, Denials

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $17 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Accounts Receivable

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This company has sponsored H1B visas in the past.

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Carle Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

🏥 Healthcare

📚 Education

Healthcare Insurance • Healthcare • Education

Carle Health is a comprehensive healthcare provider dedicated to managing the health needs of its community. Offering a wide range of services, from general medical care to specialized treatments in oncology, cardiovascular, pediatrics, and women's health, Carle Health emphasizes quality patient care and community health initiatives. Additionally, it supports education and research through the Carle Illinois College of Medicine and engages in community health programs that aim to improve overall well-being.

📋 Description

• Manage accounts receivable according to compliance, regulatory, billing, and payer guidelines • Collect outstanding receivables through payer portals and phone lines • Validate coverage and accurately bill insurance claims • Resolve charge review edits, claim edits, clearinghouse rejections, and payer rejections • Follow up on outstanding receivables and complete basic appeals • Answer, document, and complete inquiries from insurance companies, internal departments, patients, public agencies, and third-party payers • Monitor, research, and resolve unpaid, rejected, denied, and allowance discrepancy claims • Document collection activities in the billing system • Prepare payer corrections, corrected bills, appeals, refunds, account adjustments, and payer recoupments • Review undistributed payments and apply them to open balances • Review and resolve incoming correspondence • Collaborate with Billing, Coding, Cash Posting, and other departments to ensure claims are processed and paid correctly • Answer department calls through a rotation line and direct callers as appropriate • Perform other duties as assigned

🎯 Requirements

• Ability to take initiative, accept direction, and seek guidance appropriately • Ability to manage confidential information with sensitivity and discretion in a HIPAA-compliant way • Strong problem-solving and critical thinking skills • Ability to submit accurate electronic and paper insurance claims • Ability to submit non-complex reconsiderations and appeals via paper, fax, or web portal • Ability to monitor, research, and resolve unpaid, rejected, denied, and allowance discrepancy claims • Ability to analyze accounts and determine appropriate account-resolution actions • Ability to use clinical applications, payer websites, and other systems to retrieve medical documentation, eligibility information, billing guidelines, referrals, and procedure-code authorizations • Ability to resolve insurance setup errors, charge review edits, claim edits, clearinghouse rejections, and payer rejections • Ability to evaluate credit/balance accounts and initiate refunds or payer recoupments • Certifications, education, and work experience are not specified

🏖️ Benefits

• Comprehensive benefits package • Flexible schedule once trained

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