Insurance AR Specialist: Claims & Collections

Carle; Champaign (IL); On-site; USD 24,000 - 39,000; Full time

Job summary

Carle Health seeks an Accounts Receivables Insurance Specialist 1 to manage insurance claim submissions and follow-up. You will verify coverage, resolve edits, and handle payer rejections across community, government, and commercial plans.

The role collaborates with Billing, Coding and Cash Posting to ensure timely processing and accurate revenue realization. HIPAA-compliant handling is essential.

Responsibilities

• Timely and accurate claims submissions to health insurance carriers for community, government and commercial health plans.
• Submit non-complex reconsiderations and appeals via paper, fax or web portal.
• Monitor, research and resolve unpaid, rejected and/or allowance discrepancy claims.
• Manage all aspects of account follow up and collections, as assigned.
• Analyze accounts and determine the next action for resolution.
• Document pertinent collection activities in the billing system.
• Determine and initiate payer corrections and/or appeals per payer requirements.
• Utilize payer portals, clinical applications and other systems to retrieve documentation and eligibility information.
• Respond to inquiries from patients and insurance companies, internal departments and 3rd party payers.
• Identify and resolve insurance setup errors to facilitate timely billing.
• Resolve charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing.
• Evaluate credit/balance accounts and take action including refunds or recoupments.
• Evaluate accounts in an allowance discrepancy status against system contracts.
• Meticulously prepare appeals for appropriate reimbursement from payers.
• Prepare adjusted/corrected bills or refunds per operating procedures.
• Assist callers on rotation and direct to the appropriate representative.

Job description

Carle Health seeks an Accounts Receivables Insurance Specialist 1 to manage insurance claim submissions and follow-up. You will verify coverage, resolve edits, and handle payer rejections across community, government, and commercial plans.

The role collaborates with Billing, Coding and Cash Posting to ensure timely processing and accurate revenue realization. HIPAA-compliant handling is essential.