Accounts Receivable Insurance Specialist – Eligibility and Registration

Carle Health

. Manage accounts receivable in accordance with compliance, regulatory, billing, and payer guidelines .

Posted 11/5/2026full-timeRemote • Illinois • United StatesMid-LevelSenior💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing accounts receivable, ensuring compliance with billing and payer guidelines, and effectively resolving claims issues. Proficient in submitting accurate insurance claims and handling appeals while maintaining confidentiality in a HIPAA-compliant manner.

Highest-signal resume keywords

Accounts Receivable ManagementInsurance Claims SubmissionHIPAA ComplianceProblem-Solving SkillsPayer Appeals Processing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Eligibility and RegistrationInsurance Claims ProcessingClaim Edits ResolutionCharge Review EditsClearinghouse RejectionsMedical Documentation RetrievalAccounts Receivable AdjustmentsRefund ProcessingPayer RecoupmentsAllowance-Discrepancy Resolution

Soft Skills

InitiativeCritical ThinkingDiscretionCollaborationCommunication

Tools & Technologies

Clinical ApplicationsPayer WebsitesBilling Systems

Industry Keywords

ComplianceRegulatory GuidelinesBilling GuidelinesPayer GuidelinesThird-Party Payers

About the role

Key responsibilities & impact

Manage accounts receivable in accordance with compliance, regulatory, billing, and payer guidelines
Collect outstanding receivables through payer portals and phone lines
Validate coverage and accurately bill insurance claims
Resolve charge review edits, claim edits, clearinghouse rejections, and payer rejections
Follow up on outstanding receivables and complete basic appeals
Answer, document, and complete inquiries from insurance companies, internal departments, and third-party payers
Collaborate with Billing, Coding, Cash Posting, and other departments to ensure claims are processed and paid correctly
Submit timely and accurate claims for community, government, and commercial health plans
Submit reconsiderations and appeals for assigned health insurance carriers
Research and resolve unpaid, rejected, denied, and allowance-discrepancy claims
Document collection activities accurately in the billing system
Retrieve medical documentation, patient eligibility information, billing guidelines, referrals, and authorizations using clinical applications and payer websites
Apply undistributed payments to open balances as applicable
Review and resolve incoming correspondence
Identify, prepare, and request account adjustments
Respond to patient, insurance company, public agency, internal department, and third-party payer inquiries
Evaluate allowance discrepancies and prepare payer appeals, corrected bills, accounts receivable adjustments, or refunds
Answer departmental calls on a rotating line and direct callers as needed
Perform other duties as assigned

Requirements

What you’ll need

Eligibility and Registration experience required (as stated in the title)
Ability to take initiative while accepting direction and seeking guidance appropriately
Ability to manage confidential information sensitively and discreetly in a HIPAA-compliant way
Strong problem-solving and critical thinking skills
Ability to submit accurate electronic and paper insurance claims
Ability to submit non-complex reconsiderations and appeals via paper, fax, or web portal
Ability to monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims
Ability to analyze accounts and determine appropriate account-resolution actions
Ability to use clinical applications, payer websites, and other systems to research medical documentation, eligibility information, billing guidelines, referrals, and authorizations
Ability to resolve insurance setup errors, charge review edits, claim edits, clearinghouse rejections, and payer rejections
Ability to evaluate credit/balance accounts and process refunds or payer recoupments
Ability to prepare appeals, adjusted/corrected bills, accounts receivable adjustments, and refunds according to procedures

Benefits

Comp & perks

Comprehensive benefits package
Equal Opportunity Employer
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