Accounts Receivable Insurance Specialist – Eligibility and Registration

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee accounts receivable in line with compliance, regulatory, billing, and payer guidelines.

• Retrieve outstanding receivables through payer portals and communication lines.

• Confirm coverage and ensure accurate billing of insurance claims.

• Address charge review edits, claim edits, clearinghouse rejections, and payer rejections.

• Follow up on unpaid receivables and conduct basic appeals.

• Respond to, document, and resolve inquiries from insurance providers, internal departments, and third-party payers.

• Work collaboratively with Billing, Coding, Cash Posting, and other departments to guarantee proper processing and payment of claims.

• Timely and accurately submit claims for community, government, and commercial health plans.

• Prepare and submit reconsiderations and appeals for designated health insurance carriers.

• Investigate and resolve unpaid, rejected, denied, and allowance-discrepancy claims.

• Accurately document collection activities in the billing system.

• Obtain medical documentation, patient eligibility details, billing guidelines, referrals, and authorizations using clinical applications and payer websites.

• Allocate undistributed payments to open balances as necessary.

• Review and address incoming correspondence.

• Identify, prepare, and request adjustments to accounts.

• Handle inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.

• Assess allowance discrepancies and prepare payer appeals, corrected bills, accounts receivable adjustments, or refunds.

• Manage departmental calls on a rotating line and direct callers as required.

• Perform additional duties as assigned.

⛳️ Requirements

• Experience in Eligibility and Registration is essential (as indicated in the title).

• Capacity to take initiative while appropriately seeking direction and guidance.

• Ability to handle confidential information with sensitivity and discretion in a HIPAA-compliant manner.

• Strong problem-solving and critical thinking abilities.

• Proficiency in submitting accurate electronic and paper insurance claims.

• Capability to file non-complex reconsiderations and appeals via paper, fax, or web portal.

• Skill in monitoring, researching, and resolving unpaid, rejected, denied, and allowance-discrepancy claims.

• Competence in analyzing accounts to determine suitable account-resolution actions.

• Familiarity with clinical applications, payer websites, and other systems for researching medical documentation, eligibility information, billing guidelines, referrals, and authorizations.

• Ability to rectify insurance setup errors, charge review edits, claim edits, clearinghouse rejections, and payer rejections.

• Proficiency in evaluating credit/balance accounts and processing refunds or payer recoupments.

• Capability to prepare appeals, adjusted/corrected bills, accounts receivable adjustments, and refunds following established procedures.

🏝️ Benefits

• Comprehensive benefits package.

• Equal Opportunity Employer.

• E-Verify participation.