Role Description
The Accounts Receivables Insurance Specialist 1 manages the accounts receivable in accordance with compliance, regulatory and billing guidelines and specific payer rules. Responsible for collection of outstanding receivables through payer portals and/or phone lines. Responsible for the accurate billing of insurance claims by validating coverage, resolving charge review edits, claim edits and front-end clearinghouse and payer rejections. In addition, follows up on outstanding receivables; completes basic appeals; answers, documents and completes inquiries from insurance companies, internal departments, and 3rd party payers. Works collaboratively with other departments such as Billing, Coding, Cash Posting, etc. to ensure claims are processed/paid correctly.
Responsibilities
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Ability to take initiative but also accept direction and seek guidance appropriately.
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Ability to manage confidential information with sensitivity and discretion (in a HIPAA-compliant way).
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Strong problem-solving and critical thinking skills.
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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.
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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.
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Monitoring, researching, and resolving unpaid, rejected, denied and/or allowance discrepancy claims.
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Responsible for all aspects of account follow up and collections, as assigned.
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Ability to analyze accounts and determine the next appropriate action for account resolution.
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Accurately and thoroughly document the pertinent collection activities in the billing system.
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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.
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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.
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Review account level undistributed payments for application to open balances as it applies to assigned payer(s).
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Reviews and resolves incoming correspondence.
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Identifies, prepares and appropriately requests adjustments.
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Responds to inquiries from patients, insurance companies, public agencies, internal departments and 3rd party payers.
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Identifies and resolves insurance set up errors to facilitate timely billing.
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Resolves charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing, as assigned.
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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.
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Evaluates accounts in an allowance discrepancy status against system loaded contract.
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Meticulously prepares appeals for appropriate reimbursement from payers.
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May prepare adjusted and corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with existing operating procedures.
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May be required to answer calls coming into the department through a rotation line.
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Will assist or direct callers to the appropriate representative to resolve issues.
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Performs other duties as assigned.
Qualifications
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Certifications:
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Education:
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Work Experience:
Benefits
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The compensation range for this position is $17.26 per hour - $27.96 per hour.
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Carle Health offers a comprehensive benefits package for team members and providers.
Company Description
At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities.
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Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.
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We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers.
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We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school.
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Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care.
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We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
