Carle Health एक एकीकृत स्वास्थ्य सेवा संगठन है, जो सामान्य चिकित्सा देखभाल और ऑन्कोलॉजी, हृदय संबंधी देखभाल, बाल चिकित्सा तथा महिलाओं के स्वास्थ्य सहित विशेष सेवाओं के माध्यम से समुदाय की स्वास्थ्य संबंधी आवश्यकताओं को पूरा करता है। इसका कार्य Carle Illinois College of Medicine के माध्यम से चिकित्सा शिक्षा और अनुसंधान तक भी विस्तृत है। साथ ही, संगठन की सामुदायिक स्वास्थ्य पहलें समग्र कल्याण में सुधार पर केंद्रित हैं। इसके व्यापक स्वास्थ्य सेवा और शिक्षा संबंधी संचालन से क्लिनिकल, प्रशासनिक, अनुसंधान तथा संबंधित पेशेवर टीमों में अवसरों का समर्थन होता है।
Accounts Receivable Insurance Specialist (HB, PB & Denials)
Handle healthcare insurance claims, denials, appeals, and collections remotely. Support accurate reimbursement for Carle Health’s Illinois care network.
विवरण
- Oversee accounts receivable in line with regulatory, billing, and payer requirements
- Collect overdue balances through payer portals and phone calls
- Confirm coverage and submit accurate insurance claims
- Correct charge and claim edits, clearinghouse rejections, and payer rejections
- Pursue outstanding balances and prepare basic appeals
- Respond to and document inquiries from insurers, internal teams, and third-party payers
- Coordinate with Billing, Coding, Cash Posting, and other teams to support accurate claim processing and payment
- Investigate and resolve unpaid, rejected, denied, and allowance-discrepancy claims
- Record collection work accurately in the billing system
- Use clinical applications and payer websites to research medical records, eligibility, billing rules, referrals, and authorizations
- Review unassigned payments and apply them to outstanding balances
- Process and resolve incoming correspondence
- Identify account adjustment needs and submit requests
- Correct insurance setup issues to support timely billing
- Review credit and balance accounts, processing refunds or payer recoupments
- Prepare appeals, corrected bills, accounts receivable adjustments, and refunds
- Answer calls on the department’s rotating line and route callers appropriately
- Complete other assigned duties
आवश्यकताएँ
- Experience with hospital billing (HB), professional billing (PB), and denials
- Able to take initiative, follow direction, and seek guidance when appropriate
- Handles confidential information discreetly and in compliance with HIPAA
- Strong problem-solving and critical-thinking abilities
- Able to submit accurate electronic and paper insurance claims
- Able to submit straightforward reconsiderations and appeals by mail, fax, or web portal
- Able to monitor, investigate, and resolve unpaid, rejected, denied, and allowance-discrepancy claims
- Able to analyze accounts and determine appropriate next steps
- Able to use clinical applications, payer websites, and other systems to retrieve medical records, eligibility details, billing rules, referrals, and authorizations
- Able to correct insurance setup issues, charge and claim edits, clearinghouse rejections, and payer rejections
- Able to review credit and balance accounts and process refunds or payer recoupments
- Able to prepare appeals, corrected bills, account adjustments, and refunds in accordance with procedures
- Able to answer department calls and route callers appropriately
लाभ
- Comprehensive benefits package
- Equal opportunity employer
- Opportunities for growth and long-term careers