Accounts Receivable (AR) & Denial Specialist
Heritage Behavioral Health Center- HBHC, Decatur, IL, United States
Accounts Receivable (AR) & Denial Specialist
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
Required Qualifications
High school diploma or equivalent required; Associate's degree preferred
13 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
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
Required Qualifications
High school diploma or equivalent required; Associate's degree preferred
13 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