Insurance Specialist II - Corporate Patient AR Mgmt - Full Time

Guthrie Careers • Towanda, PA

80d

About The Position

The Insurance Specialist II fulfills all requirements of Insurance Specialist I, while also serving as a group leader by participating in staffing and employment issues. This role serves as a resource specialist within the department, training Insurance Billing Specialists I and related support staff. The Insurance Specialist II works closely with the Director, Manager, Supervisor, and Application Analyst on day-to-day priorities to maintain a high level of integrity within the unit. The position involves taking necessary actions to complete all types of complex insurance billings and appeals, reviewing and analyzing insurance processing procedures to identify potential problem areas, and making suggestions for more streamlined processing. Additionally, the role includes preparing reports as required and requested, working with insurance payers on problem claims and processes, and resolving outstanding Accounts Receivable and credit balances as assigned.

Requirements

• High school diploma or equivalency required.
• Minimum 3 years experience in insurance billing or CPC certified.
• Must demonstrate current competencies applicable to the job.
• Proven experience in performing required tasks independently while contributing to the team environment.
• Must maintain knowledge of medical terminology, CPT and ICD-10 Coding, and insurance regulations.
• Strong organizational and customer service skills.
• Previous experience in a high volume and fast-paced environment.
• Demonstration of self-motivation to develop and maintain knowledge and skills for the position.

Nice To Haves

• CPC, CCA, RHIA, RHIT certification in medical billing and coding or Associates degree preferred.

Responsibilities

• Identifies and evaluates denials for assigned payers and/or specialties to determine specific issues and patterns that need to be addressed.
• Serves on Denial Task Force(s) and assists in developing action plans to reduce denials and streamline clean claim submissions.
• Exports data, prepares spreadsheets, creates and runs reports as needed to be used in the resolution of outstanding claims.
• Identifies trends and provides appropriate follow-up for claims that require correction/appeal.
• Demonstrates skills and proficiency in analyzing complex billing problems, prepares appeals, challenges payer policies, and pursues appeal turnover when necessary.
• Works with team and department management to develop and train internal rejection protocols.
• Keeps current with coding knowledge, reimbursement policies, payer guidelines, and other sources to ensure best practice procedures are followed.
• Ensures staff adherence to protocols by audit and education.
• Identifies and promptly reports payer, system, or billing issues.
• Works with Applications Analyst, Supervisor, Manager, and/or Director to provide recommendations and resolution.
• Works with team and payers to ensure timely resolution of credit balances as assigned.
• Aids in the preparation of annual escheatment documentation.
• Leads any payer-specific external claim audit activity, in combination with Management, Compliance, Medical Records, and Clinical Operations.
• Serves as a group leader by performing duties such as employee training, routing work assignments, and participation in employment issues.
• Reviews requested adjustments from Specialists, approving low dollar adjustments within policy guidelines.
• Gathers all information or documentation needed for Director approval of high dollar adjustments.
• Performs testing and monitoring of new system logic or processes with Business Analyst and/or Manager.

What This Job Offers

• Education Level: High school or GED