Accounts Receivable Insurance Specialist - HB, Denials

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 front-end clearinghouse and 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 role works collaboratively with Billing, Coding, Cash Posting, and other departments to help ensure claims are processed and paid correctly.

Requirements

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

Responsibilities

Submit accurate and timely electronic and paper claims to assigned community, government, and commercial health insurance plans.
Submit non-complex reconsiderations and appeals to assigned 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, analyze accounts, and determine appropriate actions for resolution.
Accurately document collection activities 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 corrected claims, 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 adjustments.
Respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.
Identify and resolve insurance setup errors and charge review edits, claim edits, clearinghouse rejections, and payer rejections to facilitate accurate and timely 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 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.