Accounts Receivable Insurance Specialist - Must have HB , denials. Medicare and Medicare Advantage experience

Carle Health•Champaign, IL

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 billing by validating coverage and resolving charge-review edits, claim edits, and clearinghouse or payer rejections. The specialist follows up on outstanding receivables, completes basic appeals, and responds to and documents inquiries from insurance companies, internal departments, and third-party payers. The position works collaboratively with departments such as Billing, Coding, and Cash Posting to help ensure claims are processed and paid correctly. The specialist submits and follows up on claims, researches and resolves unpaid, rejected, denied, or discrepant accounts, and determines appropriate actions for account resolution. Duties also include documenting collection activity, preparing payer corrections and appeals, using clinical applications and payer websites to obtain supporting information, reviewing correspondence and undistributed payments, resolving insurance setup errors, and evaluating credit and balance accounts. The role may involve preparing adjusted or corrected bills, adjusting accounts receivable entries, issuing refunds, initiating payer recoupments, and answering calls through a departmental rotation line.

Requirements

Experience with hospital billing (HB) and denials, as indicated in the job title.
Medicare and Medicare Advantage experience, as indicated in the job title.
Ability to take initiative, accept direction, and seek guidance appropriately.
Ability to manage confidential information with sensitivity and discretion in a HIPAA-compliant manner.
Strong problem-solving and critical-thinking skills.

Responsibilities

Submit timely and accurate electronic and paper insurance claims to assigned community, government, and commercial health plans.
Submit non-complex reconsiderations and appeals to health insurance carriers through paper, fax, or web portals.
Monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims.
Perform account follow-up and collections and determine appropriate actions to resolve accounts.
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 retrieve medical documentation, eligibility information, billing guidelines, referrals, and authorization information supporting claim corrections, appeals, and coding reviews.
Review undistributed payments for application to open balances for assigned payers.
Review and resolve incoming correspondence.
Identify, prepare, and request appropriate account adjustments.
Respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.
Identify and resolve insurance setup errors and resolve charge-review edits, claim edits, and clearinghouse or payer rejections.
Evaluate credit and balance accounts and take appropriate action, including sending refunds or initiating payer recoupments through web portals.
Evaluate allowance-discrepancy accounts against system-loaded contracts and prepare appeals to obtain appropriate reimbursement.
Prepare adjusted or corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with operating procedures, as needed.
Answer calls through a departmental 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.