Accounts Receivable; AR & Denial Specialist

Job Title

Accounts Receivable (AR) & Denial Specialist

Department: Revenue Cycle / Finance
Location: Remote
Employment Type: Full-Time

Salary Range: $37,440.00 - $52,000.00

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.

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

Required 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