Insurance Specialist I – Corporate Patient AR Management – Full Time

Guthrie; Sayre (Bradford County); On-site; USD 38,000 - 60,000; Full time

Benefits offered by this job

403(b) Retirement Plan

Employee Assistance Program

PTO starts Day 1

Friendly team culture

Job summary

Guthrie is seeking an Insurance Specialist I to manage non-complex electronic and paper claim submissions, coordinate information for secondary/tertiary reviews, and ensure accurate billing. The role involves diagnosing and correcting codes, following payer guidelines, and collaborating with Billing staff to resolve issues.

Ideal candidates have a high school diploma and relevant billing/coding certification or AS degree, with strong organizational and customer service skills, plus experience

Qualifications

• High school diploma required; billing/coding certification or AS degree preferred.
• Experience with Epic system and insurance billing practices.
• Strong organizational and customer service skills.

Responsibilities

• Submit pre-AR edits, paper claims, and work queues for accurate payer submissions.
• Collaborate with Denial Resolution staff to train on payers and tasks.
• Follow up on rejected/non-responded claims using payer guidelines and coding knowledge.
• Enter charges and post insurance/patient payments.
• Ensure timely resolution of credits and adjustments.

Skills

Customer service

Attention to detail

Billing knowledge

Communication

Education

High school diploma

Medical billing/coding cert or AS degree

Tools

Epic

Job description

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.

Why Choose Guthrie:

• 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


• Friendly, Inclusive Work Family — Be part of a team that feels like home

Recognized as a Top Healthcare Employer:

Guthrie is consistently recognized for its strong workplace culture and commitment to caregiver well‑being, including:

• Best Places to Work 2025 – Modern Healthcare


• America’s Greatest Workplaces in Healthcare 2025, 2026 – Newsweek


• America’s Best-In-State Employers (PA) 2025 – Forbes


• America’s Best Employers for Healthcare Professionals 2025 – Forbes


• America’s Best Employers for Women 2025 — Forbes

Schedule & Coverage:

• Full Time, Day Shift

Position Summary:

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.

Education, License & Cert:

High school diploma required; CPC, CCA, RHIA, RHIT certification in medical billing and coding or Associates degree preferred.

Experience:

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.

Essential Functions:

1. 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.




2. 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.




3. 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.




4. Provides back up to Central Charge Entry and Cash Applications. Manually enters charges, posts and distributes insurance and patient payments.




5. Promptly reports payer, system or billing issues.




6. Utilizes Epic system functions accurately to perform assigned tasks. Ex: charge corrections, invoice inquiry, billing edits, insurance eligibility.




7. Exports and prepares spreadsheets, manipulating data fields for project work.




8. Identifies and provides appropriate follow up for claims that require correction or appeal.




9. Provides timely resolution of credit balance as identified and/or assigned. 10. 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.

Other Duties:

1. Provides feedback related to workflow processes in order to promote efficiency.




2. Answers phone calls and correspondence providing request information. Documents action taken and provides appropriate follow up.




3. 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.




4. Demonstrates excellent customer service skills for both internal and external customers.




5. Maintains strict confidentiality related to patient health information in accordance with HIPAA regulations.




6. Assists with and completes projects and other duties as assigned.

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