Accounts Receivable Insurance Specialist – Hospital Billing, Medicare, Denials, Dual Systems

🔥 12 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $17 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Accounts Receivable

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👻 Ghost score 0%

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

🎯 Requirements

• Must have hospital billing experience • Must have Medicare experience • Must have denials experience • Must have dual systems 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 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 respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers

🏖️ Benefits

• Comprehensive benefits package • Equal Opportunity Employer • E-Verify participation