Carle Health je integrirana zdravstvena organizacija, ki skrbi za zdravstvene potrebe skupnosti s splošno zdravstveno oskrbo in specializiranimi storitvami, vključno z onkologijo, srčno-žilno oskrbo, pediatrijo in zdravstveno oskrbo žensk. Njeno delovanje vključuje tudi medicinsko izobraževanje in raziskave v okviru ustanove Carle Illinois College of Medicine ter pobude za zdravje skupnosti, osredotočene na izboljšanje splošnega dobrega počutja. Široko področje zdravstvenega in izobraževalnega delovanja organizacije podpira priložnosti v kliničnih, administrativnih, raziskovalnih in drugih strokovnih ekipah.
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.
Opis
- 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
Zahteve
- 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
Ugodnosti
- Comprehensive benefits package
- Equal opportunity employer
- Opportunities for growth and long-term careers