Insurance Specialist II - Corporate Patient AR Management - Full Time

Guthrie Enterprise • Sayre, PA

2d • Onsite

About The Position

The Insurance Specialist II position fulfills all requirements of an Insurance Specialist I, and additionally serves as a group leader by participating in staffing and employment issues. This role acts as a resource specialist within the department, training Insurance Billing Specialists I and related support staff. The Specialist works closely with the Director, Manager, Supervisor, and Application Analyst on daily priorities to maintain a high level of integrity within the unit. Responsibilities include taking necessary actions to complete complex insurance billings and appeals, reviewing and analyzing insurance processing procedures to identify potential problem areas and suggest improvements, preparing reports, 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 a knowledge of medical terminology, CPT and ICD-10 Coding and insurance regulations.
• Strong organizational and customer service skills are a must.
• 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.
• Utilizes Epic system functions accurately to perform assigned tasks.

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 (e.g., trending, projects, worklists).
• Identifies trends and provides appropriate follow-up for claims that require correction/appeal.
• Analyzes complex billing problems and prepares appeals, challenges payer policies, and pursues appeal turnover when necessary.
• Works with the 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 through audit and education.
• Identifies and promptly reports payer, system, or billing issues.
• Works with the Applications Analyst, Supervisor, Manager, and/or Director to provide recommendations and resolution.
• Works with the 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 employee training, routing work assignments, and participating 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 the 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 to promote efficiency.
• Utilizes Epic system functions accurately to perform assigned tasks (e.g., charge corrections, invoice inquiry, credits, charge review, claim edit, 277 rejections).
• 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.

What This Job Offers

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