Accounts Receivable Insurance Specialist – HB, PB, Medicaid, Denials Experience

🔥 1 minute ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $17 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Accounts Receivable

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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, and third-party payers • Collaborate with Billing, Coding, Cash Posting, and other departments to ensure claims are processed and paid correctly • Submit claims for community, government, and commercial health plans • Monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims • Document collection activities in the billing system • Prepare payer corrections, appeals, adjusted bills, corrected bills, accounts-receivable adjustments, and refunds • Retrieve medical documentation, eligibility information, billing guidelines, referrals, and authorizations using clinical applications and payer websites • Review undistributed payments and apply them to open balances • Review and resolve incoming correspondence • Respond to patient, insurer, public agency, internal department, and third-party payer inquiries • Evaluate credit/balance accounts and initiate refunds or payer recoupments • Answer departmental calls through a rotation line and direct callers appropriately • Perform other duties as assigned

🎯 Requirements

• Must have HB (hospital billing) experience • Must have PB (professional billing) experience • Must have Medicaid experience • Must have denials experience • Ability to take initiative while accepting direction and seeking guidance appropriately • Ability to manage confidential information sensitively and discreetly in a HIPAA-compliant manner • 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 research and resolve unpaid, rejected, denied, and allowance-discrepancy claims • Ability to analyze accounts and determine appropriate resolution actions • Ability to document collection activities accurately in the billing system • Ability to use clinical applications, payer websites, and other systems to research medical documentation, eligibility, billing guidelines, referrals, and authorizations • Ability to resolve insurance setup errors, charge review edits, claim edits, clearinghouse rejections, and payer rejections • Ability to evaluate credit/balance accounts and process refunds or payer recoupments • Availability for Monday-Friday, 8am-5pm day schedule • No certification, education, or work experience requirement is explicitly stated in the Qualifications section

🏖️ Benefits

• Comprehensive benefits package • Equal Opportunity Employer • Potential for growth and life-long careers