Accounts Receivable Specialist – Insurance, HB, Denials, Appeals

🔥 1 minute ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $17 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Accounts Receivable

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 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 in accordance with compliance, regulatory, billing, and payer requirements • 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 unpaid, rejected, denied, and allowance-discrepancy claims • Complete basic reconsiderations and appeals • Answer, document, and resolve inquiries from patients, insurers, public agencies, internal departments, and third-party payers • Research medical documentation, eligibility, 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 • Request adjustments, prepare corrected bills, adjust accounts receivable entries, and process refunds as appropriate • Collaborate with Billing, Coding, Cash Posting, and other departments to ensure claims are correctly processed and paid • Answer departmental calls on a rotating basis and direct callers to the appropriate representative • Perform other duties as assigned

🎯 Requirements

• Ability to take initiative, accept direction, and seek guidance appropriately • Ability to manage confidential information sensitively and discreetly in a HIPAA-compliant way • Strong problem-solving and critical thinking skills • Experience with health insurance claims, denials, appeals, billing, and accounts receivable processes • Ability to submit electronic and paper claims, reconsiderations, and appeals • Ability to research payer portals, clinical applications, eligibility information, billing guidelines, referrals, and authorizations • Ability to analyze accounts and determine appropriate resolution actions • Ability to document collection activities accurately in billing systems • Ability to resolve denied/rejected invoices, allowance discrepancies, claim edits, charge review edits, and payer rejections • Ability to evaluate credit/balance accounts and process refunds or payer recoupments • Ability to answer departmental calls and direct inquiries appropriately

🏖️ Benefits

• Comprehensive benefits package • Equal opportunity employment • Potential for growth and life-long careers