Accounts Receivable Insurance Specialist- Experience with HB, Denials, Appeals

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 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.

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.

Certifications: Education: Work Experience:

The compensation range for this position is $17.26per hour - $27.96per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including but not limited to the candidates experience qualifications location training licenses shifts worked and compensation model.



Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit