Accounts Receivable Insurance Specialist 1

Carle Health•Champaign, IL

1h•$17 - $28

About The Position

The Accounts Receivable Insurance Specialist 1 manages accounts receivable in accordance with compliance, regulatory, billing, and payer-specific guidelines. The role collects outstanding receivables through payer portals and phone lines and supports accurate insurance claim billing by validating coverage and resolving charge review edits, claim edits, and clearinghouse and payer rejections. The specialist follows up on outstanding receivables, completes basic appeals, and responds to, documents, and resolves inquiries from insurance companies, internal departments, and third-party payers. The position works collaboratively with Billing, Coding, Cash Posting, and other departments to help ensure claims are processed and paid correctly.

Requirements

Ability to take initiative, accept direction, and seek guidance appropriately.
Ability to manage confidential information sensitively and discreetly in a HIPAA-compliant manner.
Strong problem-solving and critical-thinking skills.

Responsibilities

Submit timely and accurate electronic and paper claims to assigned community, government, and commercial health insurance carriers.
Submit timely and accurate non-complex reconsiderations and appeals through paper, fax, or web portals.
Monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims.
Perform assigned account follow-up and collections, analyze accounts, and determine appropriate next steps for resolution.
Document collection activities accurately and thoroughly in the billing system.
Resolve denied or rejected invoices and allowance discrepancies; prepare payer corrections and appeals according to payer requirements.
Use clinical applications, payer websites, and other systems to research medical documentation, eligibility, billing guidelines, referrals, and authorizations to support claim corrections, appeals, and coding reviews.
Review undistributed payments at the account level and apply them to open balances as appropriate for assigned payers.
Review and resolve incoming correspondence; identify, prepare, and request adjustments as appropriate.
Respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.
Identify and resolve insurance setup errors to facilitate timely billing.
Resolve charge review edits, claim edits, and clearinghouse and payer rejections to support accurate billing.
Evaluate credit and balance accounts and take appropriate action, including issuing refunds or initiating payer recoupments through web portals.
Evaluate allowance-discrepancy accounts against system-loaded contracts and prepare appeals to seek appropriate reimbursement.
Prepare adjusted or corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with operating procedures, as needed.
Answer department calls through a rotation line when required and assist or direct callers to the appropriate representative.
Perform other duties as assigned.
Take initiative while accepting direction and seeking guidance appropriately.
Handle confidential information sensitively and discreetly in a HIPAA-compliant manner.
Collaborate with Billing, Coding, Cash Posting, and other departments to support correct claim processing and payment.