Insurance Claims AR Specialist: Denials & Reimbursements

Carle Health; Champaign (IL); On-site; USD 23,000 - 39,000; Full time

Job summary

Carle Health in Champaign, IL seeks an Accounts Receivables Insurance Specialist 1 to manage insurance billing and collections, ensuring claims are submitted accurately and in compliance with payer rules. You will work with the Billing, Coding, and Cash Posting teams to drive timely payments and resolve denials.

Responsibilities include evaluating coverage, handling inquiries from insurers and internal stakeholders, and following up on unpaid claims, all while maintaining HIPAA-compliant

Responsibilities

• Take initiative but accept direction and seek guidance appropriately.
• Manage confidential information with sensitivity and discretion in a HIPAA-compliant way.
• Timely and accurate claims submissions to health insurance carriers for community, government and commercial plans, electronically and on paper.
• Timely submissions of non-complex reconsiderations and/or appeals via paper, fax or web portal.
• Monitor, research, and resolve unpaid, rejected, denied and/or allowance discrepancy claims.
• Document pertinent collection activities in the billing system.
• Determine and initiate action to resolve denied/rejected invoices, or those in allowance discrepancy, including payer corrections/appeals.
• Use clinical applications, payer websites and other systems to retrieve documentation and information to substantiate corrected submissions.
• Review undistributed payments for application to open balances and resolve incoming correspondence.
• Identify and request adjustments as needed.
• Respond to inquiries from patients, insurance companies, public agencies, internal departments and 3rd party payers.
• Identify and resolve insurance setup errors to facilitate timely billing.
• Resolve charge review edits, claim edits and rejections to facilitate accurate billing.
• Evaluate Credit/Balance accounts and take action to resolve, including refunds or recoupments.
• Prepare appeals for appropriate reimbursement and, if needed, adjust bills and AR entries.
• May answer calls in rotation and direct callers to the appropriate representative.
• Perform other duties as assigned.

Job description

Carle Health in Champaign, IL seeks an Accounts Receivables Insurance Specialist 1 to manage insurance billing and collections, ensuring claims are submitted accurately and in compliance with payer rules. You will work with the Billing, Coding, and Cash Posting teams to drive timely payments and resolve denials.

Responsibilities include evaluating coverage, handling inquiries from insurers and internal stakeholders, and following up on unpaid claims, all while maintaining HIPAA-compliant