Accounts Receivable Insurance Specialist – Hospital Billing, Medicaid, Denials, Dual Systems Experience

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

📋 Description

• Oversee accounts receivable in alignment with compliance, regulatory, billing, and payer standards.

• Gather outstanding receivables via payer portals and telephone communication.

• Confirm coverage and accurately process insurance claims.

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

• Follow up on unpaid receivables and perform basic appeals.

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

• Submit claims and non-complex reconsiderations or appeals promptly for community, government, and commercial health plans.

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

• Log collection activities in the billing system.

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

• Allocate undistributed payments to outstanding balances.

• Review and address incoming correspondence.

• Identify, prepare, and request adjustments to accounts.

• Rectify insurance setup errors to enable timely billing.

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

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

• Manage departmental calls through a rotation line.

• Execute additional tasks as assigned.

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

⛳️ Requirements

• Experience in Hospital Billing, Medicaid, Denials, and Dual Systems is required.

• Must possess the ability to take initiative, accept guidance, and seek assistance appropriately.

• Capability to handle confidential information with sensitivity and discretion, in accordance with HIPAA regulations.

• Strong problem-solving and critical thinking abilities are essential.

• Proficient in submitting accurate electronic and paper insurance claims.

• Ability to file non-complex reconsiderations and appeals.

• Competent in monitoring, investigating, and resolving unpaid, rejected, denied, and allowance discrepancy claims.

• Skilled at analyzing accounts and determining suitable account-resolution actions.

• Knowledgeable about payer plan requirements, billing guidelines, and health insurance processes.

• Proficient in using clinical applications, payer websites, billing systems, clearinghouses, and other research tools.

• Capable of resolving insurance setup errors, charge review edits, claim edits, and payer or clearinghouse rejections.

• Able to evaluate credit/balance accounts, manage refunds, payer recoupments, and address allowance discrepancies.

• Proficient in documenting collection activities accurately and comprehensively.

• Able to effectively respond to patients, insurance companies, public agencies, internal departments, and third-party payers.

• No specific certification, education, or work-experience minimum is required.

🏝️ Benefits

• Comprehensive benefits package offered.

• Day shift schedule, Monday to Friday from 8 am to 5 pm.

• No weekend work obligations.

• No holiday work requirements.

• No on-call responsibilities.