Accounts Receivable Insurance Specialist - HB, Denials

Carle Health•Champaign, IL

2d•$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/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 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 role works collaboratively with Billing, Coding, Cash Posting, and other departments to help ensure claims are processed and paid correctly. The position handles assigned claims for community, government, and commercial health plans through electronic and paper processes. It researches and resolves unpaid, rejected, denied, or discrepant claims; determines appropriate account-resolution actions; documents collection activity; and uses clinical applications, payer websites, and other systems to locate medical documentation and billing or eligibility information. The specialist may also prepare corrected bills, account adjustments, refunds, and payer recoupments in accordance with operating procedures, and may answer calls through a departmental rotation line.

Requirements

Take initiative while accepting direction and seeking guidance appropriately.
Manage confidential information with sensitivity and discretion in a HIPAA-compliant manner.
Demonstrate strong problem-solving and critical-thinking skills.

Responsibilities

Submit accurate claims to assigned community, government, and commercial health insurance carriers in a timely manner using electronic and paper billing.
Submit non-complex reconsiderations and appeals to health insurance carriers by paper, fax, or web portal.
Monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims.
Perform assigned account follow-up and collections, analyze accounts, and determine appropriate next actions for resolution.
Accurately document relevant collection activity 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 to support claim corrections, appeals, and coding reviews.
Review undistributed payments at the account level and apply them to open balances when appropriate 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 to facilitate timely billing.
Resolve charge-review edits, claim edits, and clearinghouse or payer rejections as assigned.
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.
Prepare appeals to seek 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 on a departmental rotation line when required and assist callers or direct them to the appropriate representative.
Perform other duties as assigned.