Insurance Specialist II - Corporate Patient AR Management - Full Time

Guthrie Enterprise•Sayre, PA

21h

About The Position

The Insurance Specialist II in Corporate Patient AR Management fulfills all requirements of an Insurance Specialist I, while also serving as a group leader involved in staffing and employment issues. This role acts as a resource specialist within the department, responsible for training Insurance Billing Specialists I and related support staff. The specialist works closely with the Director, Manager, Supervisor, and Application Analyst to manage day-to-day priorities and maintain high integrity within the unit. Key responsibilities include handling complex insurance billings and appeals, reviewing and analyzing insurance processing procedures to identify and suggest improvements, preparing reports, and collaborating with insurance payers to resolve problem claims and processes. The position also involves resolving outstanding Accounts Receivable and credit balances as assigned. The role requires a minimum of 3 years of experience in insurance billing or CPC certification, a high school diploma or equivalency, and a strong knowledge of medical terminology, CPT and ICD-10 Coding, and insurance regulations. Strong organizational and customer service skills are essential, along with proven experience in a high-volume, fast-paced environment and self-motivation to continuously develop relevant knowledge and skills.

Requirements

High school diploma or equivalency
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 a knowledge of medical terminology
Must maintain a knowledge of CPT and ICD D 10 Coding
Must maintain a knowledge of insurance regulations
Strong organizational skills
Strong customer service skills
Previous experience in performing in a high volume and fast paced environment
Demonstration of self motivation to develop and maintain the knowledge and skills for the position

Nice To Haves

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

Responsibilities

Fulfills all requirements of Insurance Specialist I
Serves as a group leader by participating in staffing and employment issues
Serves as a resource specialist within the department
Trains Insurance Billing Specialists I and related support staff
Works closely with Director, Manager, Supervisor and Application Analyst on day-to-day priorities and to maintain a high level of integrity within the unit
Takes the necessary action to complete all types of complex insurance billings and appeals
Reviews and analyzes the insurance processing procedures to identify potential problem areas and makes suggestions for more streamlined processing
Prepares reports as required and requested
Works with insurance payers on problem claims and processes
Resolves outstanding Accounts Receivable and credit balances as assigned
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 (ex. trending, projects, worklists)
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 in order to ensure best practice procedures are followed
Ensures staff adherence of 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, worked in combination with Management, Compliance, Medical Records and Clinical Operations
Serves as a group leader by performing one or more of the following duties: employee training, routing work assignment, 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 process with Business Analyst and/or Manager
Answers phone calls and correspondence providing requested information to aid in the resolution of account balances
Maintains knowledge and performs within the compliance of Guthrie Medical Group and payer guidelines
Provides feedback related to workflow processes in order to promote efficiency
Utilizes Epic system functions accurately to perform assigned tasks
Trains staff on Epic system functions as needed
Demonstrates excellent customer service skills for both internal and external customers while promoting the same in the team environment
Maintains strict confidentiality related to patient health information in accordance with HIPAA compliance
Assists with and completes projects and other duties as assigned