Accounts Receivable Specialist – Medicare, Medicare Advantage, Denials

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

📋 Description

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

• Gather outstanding receivables via payer portals and telephone communications.

• Confirm coverage and accurately bill insurance claims.

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

• Follow up on pending receivables and manage 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 for community, government, and commercial health plans.

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

• Record collection activities in the billing system.

• Prepare payer corrections and appeals using both electronic and paper methods.

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

• Assess undistributed payments and allocate them to outstanding balances.

• Review and address incoming correspondence.

• Identify and request adjustments to accounts.

• Correct insurance setup errors to ensure timely billing.

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

• Review allowance discrepancy accounts and prepare appeals for appropriate reimbursement.

• Answer or route departmental calls through a rotation line.

• Collaborate with Billing, Coding, Cash Posting, and other departments.

• Perform additional duties as required.

⛳️ Requirements

• Experience in HB and handling denials.

• Familiarity with Medicare and Medicare Advantage.

• Capacity to take initiative while also accepting direction and seeking guidance as needed.

• Proficiency in managing confidential information with sensitivity and discretion in a HIPAA-compliant manner.

• Strong problem-solving and critical thinking abilities.

• Experience with both electronic and paper insurance claim billing.

• Knowledge of submitting reconsiderations and appeals via paper, fax, or web portal.

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

• Ability to analyze accounts and determine suitable resolution actions.

• Proficiency in using clinical applications, payer websites, and other relevant systems.

• Capability to research medical documentation, eligibility information, billing guidelines, referrals, and procedure code authorizations.

• Competence in resolving insurance setup errors, charge review edits, claim edits, clearinghouse rejections, and payer rejections.

• Ability to evaluate credit/balance accounts and manage refunds or payer recoupments.

• Skill in preparing appeals, adjusted/corrected bills, accounts receivable adjustments, and refunds.

• Ability to answer departmental calls when assigned.

• Compliant handling of confidential information in accordance with HIPAA regulations.

🏝️ Benefits

• Comprehensive benefits package.