Insurance Claims A/R Specialist

Carle Health; Champaign (IL); On-site; USD 49,511,000 - 80,117,000; Full time

Job summary

Carle Health in Champaign, IL is seeking an Accounts Receivables Insurance Specialist 1 to manage billing and collections in line with payer rules and regulatory guidelines. You will verify coverage, submit claims, and resolve payer rejections to ensure timely payments.

The role requires collaboration with Billing and Coding teams, strong communication with payers, and attentive handling of inquiries. The ideal candidate will work within a HIPAA-compliant framework and demonstrate solid

Qualifications

• Certifications: , Education: , Work Experience:

Responsibilities

• Ability to take initiative but also accept direction and seek guidance appropriately.
• Ability to manage confidential information with sensitivity and discretion (in a HIPAA-compliant way).
• Strong problem-solving and critical thinking skills.
• Timely and accurate claims submissions to health insurance carriers for community, government and commercial health plans as assigned, in the form of electronic and paper billing.
• Timely and accurate submissions of non-complex reconsiderations and/or appeals to health insurance carriers for community, government and commercial health plans as assigned, via paper, fax or web portal.
• Monitoring, researching, and resolving unpaid, rejected, denied and/or allowance discrepancy claims.
• Responsible for all aspects of account follow up and collections, as assigned.
• Ability to analyze accounts and determine the next appropriate action for account resolution.
• Accurately and thoroughly document the pertinent collection activities in the billing system.
• Determines and initiates appropriate action to resolve denied and/or rejected invoices, or invoices in allowance discrepancy and prepares payer corrections and/or appeals in accordance with payer plan requirements using electronic and paper processes.
• Utilizes clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions, through written appeals, and coding reviews, etc.
• Review account level undistributed payments for application to open balances as it applies to assigned payer(s).
• Reviews and resolves incoming correspondence.
• Identifies, prepares and appropriately requests adjustments.
• Responds to inquiries from patients, insurance companies, public agencies, internal departments and 3rd party payers.
• Identifies and resolves insurance set up errors to facilitate timely billing.
• Resolves charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing, as assigned.
• Evaluates Credit/Balance accounts and performs appropriate action to resolve, including but not limited to sending refunds and/or initiating payer recoupments via web portal.
• Evaluates accounts in an allowance discrepancy status against system loaded contract.
• Meticulously prepares appeals for appropriate reimbursement from payers.
• May prepare adjusted and corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with existing operating procedures.
• May be required to answer calls coming into the department through a rotation line. Will assist or direct callers to the appropriate representative to resolve issues.
• Performs other duties as assigned.

Job description

Carle Health in Champaign, IL is seeking an Accounts Receivables Insurance Specialist 1 to manage billing and collections in line with payer rules and regulatory guidelines. You will verify coverage, submit claims, and resolve payer rejections to ensure timely payments.

The role requires collaboration with Billing and Coding teams, strong communication with payers, and attentive handling of inquiries. The ideal candidate will work within a HIPAA-compliant framework and demonstrate solid