Accounts Receivable Specialist – Insurance, HB, Denials, Appeals

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

📋 Description

• Oversee accounts receivable operations while adhering to compliance, regulatory standards, billing procedures, and payer requirements.

• Retrieve outstanding receivables through the use of payer portals and telephone communication.

• Confirm coverage and ensure accurate billing of insurance claims.

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

• Follow up on claims that are unpaid, rejected, denied, or have discrepancies in allowances.

• Conduct basic reconsiderations and appeals as necessary.

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

• Investigate medical documentation, eligibility criteria, billing guidelines, referrals, and authorizations utilizing clinical applications and payer websites.

• Assess undistributed payments and allocate them to outstanding balances.

• Review and address incoming correspondence effectively.

• Request adjustments, prepare corrected invoices, modify accounts receivable entries, and process refunds as warranted.

• Collaborate with Billing, Coding, Cash Posting, and other teams to ensure proper processing and payment of claims.

• Handle departmental calls on a rotating basis and redirect callers to the appropriate representatives.

• Perform additional tasks as assigned.

⛳️ Requirements

• Demonstrated ability to take initiative, accept direction, and seek appropriate guidance.

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

• Strong analytical and problem-solving skills.

• Experience in health insurance claims, including denials, appeals, billing, and accounts receivable processes.

• Proficient in submitting both electronic and paper claims, reconsiderations, and appeals.

• Ability to research payer portals, clinical applications, eligibility details, billing guidelines, referrals, and authorizations effectively.

• Skill in analyzing accounts to determine suitable resolution actions.

• Ability to document collection activities accurately within billing systems.

• Proficient in resolving denied or rejected invoices, allowance discrepancies, claim edits, charge review edits, and payer rejections.

• Ability to evaluate credit and balance accounts, processing refunds or payer recoupments as necessary.

• Capable of answering departmental calls and directing inquiries appropriately.

🏝️ Benefits

• Comprehensive benefits package.

• Commitment to equal opportunity employment.

• Opportunities for growth and lifelong career development.