Accounts Receivable Specialist – Medicare, Medicare Advantage, Denials

Carle Health

. Manage accounts receivable according to compliance, regulatory, billing, and payer requirements .

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing accounts receivable, including compliance with billing and payer requirements, while effectively resolving claims and appeals. Proficient in utilizing clinical applications and payer websites to ensure accurate billing and documentation.

Highest-signal resume keywords

Accounts Receivable ManagementInsurance Claim BillingMedicare ExperienceHIPAA ComplianceProblem-Solving Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims SubmissionReconsiderations and AppealsCharge Review EditsClearinghouse RejectionsPayer RejectionsCredit/Balance EvaluationRefund ProcessingMedical Documentation ResearchBilling Guidelines AnalysisEligibility Information Retrieval

Soft Skills

InitiativeCritical ThinkingSensitivity and Discretion

Tools & Technologies

Clinical ApplicationsPayer WebsitesBilling Systems

Industry Keywords

ComplianceRegulatory RequirementsPayer PortalsCommunity Health PlansGovernment Health PlansCommercial Health Plans

About the role

Key responsibilities & impact

Manage accounts receivable according to compliance, regulatory, billing, and payer requirements
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
Submit claims and non-complex reconsiderations or appeals for community, government, and commercial health plans
Monitor, research, and resolve unpaid, rejected, denied, and allowance discrepancy claims
Document collection activities in the billing system
Prepare payer corrections and appeals using electronic and paper processes
Retrieve medical documentation, eligibility information, billing guidelines, referrals, and authorizations using clinical applications and payer websites
Review undistributed payments and apply them to open balances
Review and resolve incoming correspondence
Identify and request account adjustments
Resolve insurance setup errors to facilitate timely billing
Evaluate credit/balance accounts and process refunds or payer recoupments
Evaluate allowance discrepancy accounts and prepare appeals for appropriate reimbursement
Answer or direct departmental calls through a rotation line
Collaborate with Billing, Coding, Cash Posting, and other departments
Perform other duties as assigned

Requirements

What you’ll need

Must have HB and denials experience
Medicare and Medicare Advantage experience
Ability to take initiative while accepting direction and seeking guidance appropriately
Ability to manage confidential information with sensitivity and discretion in a HIPAA-compliant way
Strong problem-solving and critical thinking skills
Experience with electronic and paper insurance claim billing
Experience submitting 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 resolution actions
Ability to use clinical applications, payer websites, and other systems
Ability to research medical documentation, eligibility information, billing guidelines, referrals, and procedure code 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
Ability to answer departmental calls when assigned
HIPAA-compliant handling of confidential information

Benefits

Comp & perks

Comprehensive benefits package