Insurance Specialist I - Corporate Patient AR Management - Full Time

Guthrie Enterprise • Sayre, PA

55d • Onsite

About The Position

Build a rewarding career at the intersection of healthcare, customer service, and problem-solving. As an Insurance Specialist I, you'll gain valuable industry knowledge while helping patients and care teams navigate the complexities of insurance and healthcare coverage. About Guthrie Towanda Hospital: At Guthrie Towanda, you’ll find more than just a job — Our 68-bed facility offers the intimacy of a small team with the backing of a nationally recognized health system.

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 or Associates degree preferred.

Responsibilities

• Responsible for non-complex electronic and paper claim submissions to insurance payers.
• Coordinates required information for filing secondary and tertiary claims.
• Reviews and analyzes claims for accuracy, i.e. diagnosis and procedure codes are compatible and accurate.
• Makes charge corrections or follows up with appropriate parties as needed to ensure billing invoice is correct.
• Follows up with payers on unresponded claims.
• Works denied claims by following correct coding and payer guidelines resulting in appeal or charge correction.
• Teams with Insurance Billing Specialist II and Denial Resolution staff to work projects, request guidance on more complex billing issues and cross training for other payers and tasks.
• Responds to a variety of questions from insurance companies, government agencies and all Guthrie Medical Group offices.
• Partners with CRC and other Guthrie departments to field billing inquiries.
• Answers all correspondence from insurance carriers including requests for supportive documentation.
• 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.

Benefits

• Voluntary 403(b) Retirement Plan – Plan for your future with Fidelity investment options
• Employee Assistance Program – Confidential support for personal and professional well-being
• PTO starts Day 1

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED