Accounts Receivable Specialist – Medicare, Medicare Advantage, Denials

🔥 0 minutes 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 according to 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 outstanding receivables and complete basic appeals • Answer, document, and complete inquiries from insurance companies, internal departments, and third-party payers • Submit claims and non-complex reconsiderations or appeals 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 and appeals using electronic and paper processes • 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 • Identify and request account adjustments • Resolve insurance setup errors to facilitate timely billing • Evaluate credit/balance accounts and process refunds or payer recoupments • Evaluate allowance discrepancy accounts and prepare appeals for appropriate reimbursement • Answer or direct departmental calls through a rotation line • Collaborate with Billing, Coding, Cash Posting, and other departments • Perform other duties as assigned

🎯 Requirements

• Must have HB and denials experience • Medicare and Medicare Advantage experience • Ability to take initiative while accepting direction and seeking guidance appropriately • Ability to manage confidential information with sensitivity and discretion in a HIPAA-compliant way • Strong problem-solving and critical thinking skills • Experience with electronic and paper insurance claim billing • Experience submitting 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 resolution actions • Ability to use clinical applications, payer websites, and other systems • Ability to research 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 process refunds or payer recoupments • Ability to prepare appeals, adjusted/corrected bills, accounts receivable adjustments, and refunds • Ability to answer departmental calls when assigned • HIPAA-compliant handling of confidential information

🏖️ Benefits

• Comprehensive benefits package

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