Accounts Receivable Insurance Specialist- Must have Eligibility and Registration experience

Carle Health•Urbana, IL

About The Position

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

Requirements

Eligibility and registration experience, as indicated in the job title.
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 accurate and timely claims to assigned community, government, and commercial health insurance carriers through electronic and paper billing.
Submit non-complex reconsiderations and appeals to assigned health insurance carriers through paper, fax, or web portals.
Monitor, research, and resolve unpaid, rejected, denied, or 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, including preparing 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 authorizations supporting claim corrections, appeals, and coding reviews.
Review undistributed payments at the account level for application to open balances for assigned payers.
Review and resolve incoming correspondence.
Identify, prepare, and request appropriate adjustments.
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 sending refunds or initiating payer recoupments through web portals.
Evaluate allowance-discrepancy accounts against system-loaded contracts.
Prepare appeals to obtain appropriate reimbursement from payers.
Prepare adjusted or corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with operating procedures, as needed.
Answer calls received through the department's rotation line when required and assist callers or direct them to the appropriate representative.
Take initiative while accepting direction and seeking guidance appropriately.
Handle confidential information sensitively and discreetly in a HIPAA-compliant manner.
Perform other duties as assigned.