Insurance Specialist I - Corporate Patient AR Management - Full Time

Guthrie Enterprise•Sayre, PA

About The Position

This position is responsible for handling non-complex electronic and paper claim submissions to insurance payers. Key duties include coordinating information for filing secondary and tertiary claims, reviewing and analyzing claims for accuracy (e.g., diagnosis and procedure codes), and making necessary charge corrections or following up with appropriate parties. The specialist will follow up on unresponded claims and work denied claims by adhering to correct coding and payer guidelines to facilitate appeals or charge corrections. The role involves collaboration with Insurance Billing Specialist II and Denial Resolution staff for project work, guidance on complex billing issues, and cross-training. Additionally, the specialist will respond to inquiries from insurance companies, government agencies, and Guthrie Medical Group offices, partner with CRC and other Guthrie departments for billing inquiries, and manage all correspondence from insurance carriers, including requests for supportive documentation.

Requirements

High school diploma required
Strong organizational and customer service skills a must
Experience with office software such as Word and Excel required
Previous experience performing in a high volume and fast paced environment

Nice To Haves

CPC, CCA, RHIA, RHIT certification in medical billing and coding
Associates degree

Responsibilities

Works pre-AR edits, paper claims, reports and work queues as assigned to ensure accurate and timely claim submission to individual payers. Reports possible payer or submission issues.
Works closely with a Denial Resolution Specialist or Billing Specialist II mentor to cross train on various payers and tasks to expand insurance billing knowledge and skills.
Follows up on rejected and/or non-responded claims as assigned. Utilizes internal rejection protocols, coding knowledge, reimbursement policies, payer guidelines and other sources in order to research rejections to secure appropriate payment.
Provides back up to Central Charge Entry and Cash Applications. Manually enters charges, posts and distributes insurance and patient payments.
Promptly reports payer, system or billing issues.
Utilizes Epic system functions accurately to perform assigned tasks. Ex: charge corrections, invoice inquiry, billing edits, insurance eligibility.
Exports and prepares spreadsheets, manipulating data fields for project work.
Identifies and provides appropriate follow up for claims that require correction or appeal.
Provides timely resolution of credit balance as identified and/or assigned.
Requests adjustments on invoices that have been thoroughly researched and/or were unable to reach payment resolution. Documents support on request forms and performs adjustments within policy guidelines.
Provides feedback related to workflow processes in order to promote efficiency.
Answers phone calls and correspondence providing request information. Documents action taken and provides appropriate follow up.
Acquires and maintains knowledge of and performs within the compliance of the Guthrie Clinic’s Corporate Revenue Cycle policies and insurance payer regulations and guidelines.
Demonstrates excellent customer service skills for both internal and external customers.
Maintains strict confidentiality related to patient health information in accordance with HIPAA regulations.
Assists with and completes projects and other duties as assigned.