About this role
Proficient in Revenue Cycle Denials Receivable Representative 1. Responsible for handling escalated account and payer issues. Handles complex edits, appeals and account activities such as advanced level tasks, bankruptcies, Risk Management. Acts as a billing and reimbursement expert for a defined payer product line.
Qualifications
Certifications: , Education: , Work Experience:
Responsibilities
Must be able to perform essential job functions of Revenue Cycle Accounts Receivable Representative 1. Handles complex edits, correspondence and advanced level workqueues such as but not limited to retro review, EOB balancing, credit adjustment review and processing of Illinois Workers’ Compensation Commission (IWCC). Handles escalated account activities such as but not limited to healthcare liens, settlement requests, workers’ compensation reimbursement computation forms and attorney requests. Handles escalated appeals. Assists with training and education to staff for accuracy. Identifies payer and system issues to initiate project requests for process improvements. Assists in credit balance review according to organization’s credit balance/refund policy. Attends and participates in meetings with payer specific provider representatives to maximize reimbursement and minimize denials through problem solving, collaboration and consensus.
About Us
Find it here.
Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].
Compensation and Benefits
The compensation range for this position is $16.73per hour - $27.1per 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 candidate’s 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 careers.carlehealth.org/benefits.
Other facts
About Carle Health
Carle Health is a vertically integrated system with a bold but simple mission: to be the trusted partner in all healthcare decisions for everyone who depends on it. Combining clinical care, health insurance, medical research and higher education, Carle Health provides highly accessible, high-quality care and service to improve health in communities throughout central Illinois and beyond. Always focused on its North Star – providing the best care possible for patients and health plan members – Carle Health is driven by a deep philanthropic spirit to solve real-world health issues now and into the future.
The system includes eight, award-winning hospitals, multispecialty physician group practices with more than 1,300 doctors and advanced practice providers, provider-driven health insurance plans including Health AllianceTM and FirstCarolinaCare, Carle Illinois College of Medicine, the world’s first engineering-based medical school, Methodist College, Stephens Family Clinical Research Institute, and other associated healthcare businesses – all working together to get patients and health plan members the care they need at the right time and at every point in their healthcare journey.
Founded in Urbana, IL, Carle Health has more than 16,800 team members working across Illinois, Indiana, Washington and North Carolina. It’s proud to be named a Great Place to Work®.
What you'll do
- This role involves handling escalated account and payer issues, managing complex edits, appeals, and advanced account activities like bankruptcies and Risk Management tasks. The representative acts as a billing and reimbursement expert for a defined payer product line.
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