Accounts Receivable Insurance Specialist – Hospital Billing, Medicare, Denials, Dual Systems

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

📋 Description

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

• Retrieve outstanding receivables through payer portals and/or phone communications.

• Verify coverage and accurately process insurance claims.

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

• Follow up on overdue receivables and complete basic appeals.

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

• Submit claims and uncomplicated reconsiderations or appeals to community, government, and commercial health plans.

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

• Record collection activities within the billing system.

• Initiate corrections and appeals with payers for denied or rejected invoices.

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

• Allocate undistributed payments to open balances.

• Review and address incoming correspondence.

• Request adjustments and fix insurance setup errors.

• Assess credit/balance accounts, issue refunds, and start payer recoupments.

• Prepare adjusted and corrected bills, modify accounts receivable entries, and issue refunds.

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

• Perform additional duties as assigned.

• Collaborate with Billing, Coding, Cash Posting, and other departments to ensure claims are processed and paid accurately.

⛳️ Requirements

• Hospital billing experience is required.

• Experience with Medicare is essential.

• Familiarity with denials is necessary.

• Experience with dual systems is preferred.

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

• Capacity to manage confidential information sensitively and discreetly in compliance with HIPAA regulations.

• Strong problem-solving and critical thinking capabilities.

• Proficient in submitting accurate electronic and paper claims.

• Ability to submit uncomplicated reconsiderations and appeals via paper, fax, or web portal.

• Skills to research and resolve unpaid, rejected, denied, and allowance-discrepancy claims.

• Ability to analyze accounts and determine suitable resolution actions.

• Competence in accurately documenting collection activities within 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 respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.

🏝️ Benefits

• Comprehensive benefits package.

• Equal Opportunity Employer.

• Participation in E-Verify.