[Hiring] Accounts Receivable (AR) & Denial Specialist @Heritage Behavioral Health Center
Role Description
The Accounts Receivable (AR) & Denial Specialist is responsible for managing and resolving outstanding accounts receivable and claim denials for healthcare services provided in the State of Illinois. This role supports reimbursement across commercial payors, Medicare, Illinois Medicaid Managed Care plans, fee-for-service (FFS), and grant-funded programs, ensuring timely follow-up, accurate appeals, and compliance with applicable state and federal requirements.
Essential Duties and Responsibilities
• Accounts Receivable Management
• Monitor and work AR aging reports for Illinois-based claims across commercial, Medicare, managed care, FFS, and grant-funded programs.
• Perform timely follow-up on unpaid, underpaid, or delayed claims in accordance with Illinois and payor-specific timely filing guidelines.
• Review and reconcile payments, adjustments, and remittance advice (EOBs/ERAs).
• Accurately document all AR activity and payor communications in billing and financial systems.
• Denial Management & Appeals
• Review, analyze, and resolve claim denials and rejections from commercial payors, Medicare, and Illinois Medicaid Managed Care Organizations.
• Identify root causes of denials, including eligibility, authorization, coding, documentation, timely filing, and contract-related issues.
• Prepare and submit corrected claims, reconsiderations, and appeals within required timelines.
• Track appeal outcomes and escalate unresolved or complex denials as appropriate.
• Identify denial trends and provide feedback to billing, coding, and operational teams to reduce future denials.
• Managed Care, FFS & Grant Support
• Work AR and denials related to Illinois Medicaid managed care plans and fee-for-service claims.
• Track and reconcile grant-funded billing and reimbursement activity in accordance with grant requirements.
• Support documentation requests, audits, and reviews related to grant reimbursements.
• Compliance & Reporting
• Ensure AR and denial activities comply with CMS, Medicare, Illinois HFS, managed care, and commercial payor requirements.
• Maintain documentation to support internal audits, external audits, and compliance reviews.
• Assist with AR, denial, and collection reporting as requested.
• Collaboration & Communication
• Communicate with payor representatives, managed care plans, and internal teams to resolve claim issues.
• Collaborate with billing, coding, credentialing, and clinical teams to support accurate reimbursement.
• Provide clear, professional communication regarding claim status and resolution.
Qualifications
• High school diploma or equivalent required; Associate’s degree preferred.
• 1–3 years of experience in healthcare accounts receivable, billing, or denial management.
• Experience working with Illinois commercial payors, Medicare, and/or Illinois Medicaid Managed Care.
• Knowledge of timely filing requirements and appeal processes.
• Proficiency with billing systems, clearinghouses, and payor portals.
• Strong attention to detail and organizational skills.
Preferred Qualifications
• Experience working with Illinois Medicaid (HFS) and managed care plans (e.g., Aetna Better Health, Meridian, Molina, BCBS Community).
• Knowledge of CPT, HCPCS, and ICD-10 coding.
• Experience with grant-funded billing and reimbursement.
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The Accounts Receivable (AR) & Denial Specialist is responsible for managing and resolving outstanding accounts receivable and claim denials for healthcare services provided in the State of Illinois. This role supports reimbursement across commercial payors, Medicare, Illinois Medicaid Managed Care plans, fee-for-service (FFS), and grant-funded programs, ensuring timely follow-up, accurate appeals, and compliance with applicable state and federal requirements.
Essential Duties and Responsibilities
• Accounts Receivable Management
• Monitor and work AR aging reports for Illinois-based claims across commercial, Medicare, managed care, FFS, and grant-funded programs.
• Perform timely follow-up on unpaid, underpaid, or delayed claims in accordance with Illinois and payor-specific timely filing guidelines.
• Review and reconcile payments, adjustments, and remittance advice (EOBs/ERAs).
• Accurately document all AR activity and payor communications in billing and financial systems.
• Denial Management & Appeals
• Review, analyze, and resolve claim denials and rejections from commercial payors, Medicare, and Illinois Medicaid Managed Care Organizations.
• Identify root causes of denials, including eligibility, authorization, coding, documentation, timely filing, and contract-related issues.
• Prepare and submit corrected claims, reconsiderations, and appeals within required timelines.
• Track appeal outcomes and escalate unresolved or complex denials as appropriate.
• Identify denial trends and provide feedback to billing, coding, and operational teams to reduce future denials.
• Managed Care, FFS & Grant Support
• Work AR and denials related to Illinois Medicaid managed care plans and fee-for-service claims.
• Track and reconcile grant-funded billing and reimbursement activity in accordance with grant requirements.
• Support documentation requests, audits, and reviews related to grant reimbursements.
• Compliance & Reporting
• Ensure AR and denial activities comply with CMS, Medicare, Illinois HFS, managed care, and commercial payor requirements.
• Maintain documentation to support internal audits, external audits, and compliance reviews.
• Assist with AR, denial, and collection reporting as requested.
• Collaboration & Communication
• Communicate with payor representatives, managed care plans, and internal teams to resolve claim issues.
• Collaborate with billing, coding, credentialing, and clinical teams to support accurate reimbursement.
• Provide clear, professional communication regarding claim status and resolution.
Qualifications
• High school diploma or equivalent required; Associate’s degree preferred.
• 1–3 years of experience in healthcare accounts receivable, billing, or denial management.
• Experience working with Illinois commercial payors, Medicare, and/or Illinois Medicaid Managed Care.
• Knowledge of timely filing requirements and appeal processes.
• Proficiency with billing systems, clearinghouses, and payor portals.
• Strong attention to detail and organizational skills.
Preferred Qualifications
• Experience working with Illinois Medicaid (HFS) and managed care plans (e.g., Aetna Better Health, Meridian, Molina, BCBS Community).
• Knowledge of CPT, HCPCS, and ICD-10 coding.
• Experience with grant-funded billing and reimbursement.
Apply tot his job
Apply To this Job