Accounts Receivable Insurance Specialist – HB, PB, Medicaid, Denials Experience

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

📋 Description

• Oversee accounts receivable in accordance with compliance, regulatory standards, billing protocols, and payer guidelines.

• Retrieve outstanding receivables through payer portals and phone communication.

• Confirm coverage and accurately process insurance claims.

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

• Follow up on pending receivables and manage basic appeals.

• Answer, document, and resolve inquiries from insurance providers, internal teams, and third-party payers.

• Work collaboratively with Billing, Coding, Cash Posting, and other departments to ensure accurate claim processing and payments.

• Submit claims for community, government, and commercial health insurance plans.

• Monitor, investigate, and address unpaid, rejected, denied, and allowance-discrepancy claims.

• Record collection activities within the billing system.

• Prepare payer corrections, appeals, adjusted invoices, corrected bills, accounts-receivable adjustments, and refunds.

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

• Review undistributed payments and allocate them to outstanding balances.

• Assess and resolve incoming correspondence.

• Respond to inquiries from patients, insurers, public agencies, internal departments, and third-party payers.

• Analyze credit/balance accounts and initiate refunds or payer recoupments.

• Handle departmental calls through a rotation line and direct callers as needed.

• Perform additional duties as assigned.

⛳️ Requirements

• Prior experience in hospital billing (HB) is required.

• Prior experience in professional billing (PB) is required.

• Experience with Medicaid is required.

• Familiarity with handling denials is required.

• Ability to take initiative while appropriately accepting direction and seeking guidance.

• Capability to manage confidential information with sensitivity and in compliance with HIPAA regulations.

• Strong problem-solving and critical thinking abilities.

• Proficiency in submitting accurate electronic and paper insurance claims.

• Capability to submit straightforward reconsiderations and appeals through paper, fax, or web portals.

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

• Ability to analyze accounts and determine suitable resolution actions.

• Capability to accurately document collection activities in the billing system.

• Proficient in using clinical applications, payer websites, and other systems to research medical documentation, eligibility, billing guidelines, referrals, and authorizations.

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

• Capability to evaluate credit/balance accounts and process refunds or payer recoupments.

• Availability for a Monday to Friday schedule from 8 AM to 5 PM.

• No specific certification, education, or work experience requirements are stated in the qualifications section.

🏝️ Benefits

• Comprehensive benefits package.

• Equal Opportunity Employer.

• Opportunities for growth and long-lasting careers.