Insurance Specialist II - Corporate Patient AR Management - Full Time

Guthrie; Sayre (Bradford County); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

403(b) retirement plan

Employee Assistance Program

PTO starts Day 1

Supportive work culture

Job summary

Guthrie is seeking an Insurance Specialist II to lead billing operations, train staff, and collaborate with leadership to optimize insurance processing and appeals. The role emphasizes denials management, accurate reporting, and adherence to payer guidelines in a high-volume environment.

Candidates should have CPC/CODE certifications preferred, 3+ years of billing experience, and strong CPT/ICD-10 knowledge. The position supports a day shift within Guthrie’s healthcare network.

Qualifications

• High school diploma or equivalent required.
• CPC, CCA, RHIA, or RHIT certification preferred.
• Associate degree preferred.
• Three years of insurance billing experience or CPC certification required.
• Strong knowledge of CPT/ ICD-10 and payer regulations.

Responsibilities

• Identify and address denials; support denial task forces.
• Export data, prepare reports, and resolve outstanding claims.
• Analyze complex billing issues and prepare appeals.
• Train staff on rejection protocols and HIPAA-compliant practices.
• Ensure timely resolution of credit balances and escheatment prep.
• Provide excellent customer service to internal and external customers.

Skills

Customer service

Denial management

Data analysis

Team leadership

Medical billing terminology

Education

High school diploma or equivalent

CPC, CCA, RHIA, or RHIT certification

Associate degree

Tools

Epic

Job description

Build a Rewarding Career at the Intersection of Healthcare, Customer Service, and Problem-Solving

As an Insurance Specialist II, 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 with Fidelity investment options
• Employee Assistance Program providing confidential support for personal and professional well-being
• PTO starts Day 1
• Friendly, inclusive work family where you'll feel valued and supported

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:

Fulfills all requirements of the Insurance Specialist I role while serving as a group leader by participating in staffing and employment-related activities. Serves as a departmental resource specialist and provides training to Insurance Billing Specialists I and related support staff. Works closely with the Director, Manager, Supervisor, and Application Analyst on daily priorities to maintain a high level of integrity within the unit. Takes the necessary action to complete complex insurance billings and appeals. Reviews and analyzes insurance processing procedures to identify potential problem areas and recommends process improvements. Prepares reports as required and requested, collaborates with insurance payers on problem claims and processes, and resolves outstanding accounts receivable and credit balances as assigned.

Education:

• High school diploma or equivalent required.
• CPC, CCA, RHIA, or RHIT certification in medical billing and coding preferred.
• Associate degree preferred.

Experience:

• Minimum of three years of insurance billing experience or CPC certification required.
• Must demonstrate current competencies applicable to the position and have proven experience performing required tasks independently while contributing to a team environment. Must maintain knowledge of medical terminology, CPT coding, ICD-10 coding, and insurance regulations. Strong organizational and customer service skills are essential.
• Previous experience working in a high-volume, fast-paced environment is required, along with demonstrated self-motivation to develop and maintain the knowledge and skills necessary for success in the role.

Essential Functions:

1. 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 Forces and assists in developing action plans to reduce denials and streamline clean claim submissions.
2. Exports data, prepares spreadsheets, and creates and runs reports used in resolving outstanding claims, including trending reports, special projects, and worklists. Identifies trends and provides follow-up for claims requiring correction or appeal.
3. Demonstrates proficiency in analyzing complex billing problems, preparing appeals, challenging payer policies, and pursuing appeal turnover when necessary.
4. Works with the team and department management to develop and train staff on internal rejection protocols. Maintains current knowledge of coding requirements, reimbursement policies, payer guidelines, and industry best practices.
5. Ensures staff adherence to protocols through auditing and education.
6. Identifies and promptly reports payer, system, or billing issues. Works with the Applications Analyst, Supervisor, Manager, and Director to provide recommendations and support resolution efforts.
7. Works with the team and payers to ensure timely resolution of assigned credit balances. Assists with preparation of annual escheatment documentation.
8. Leads payer-specific external claim audit activities in collaboration with Management, Compliance, Medical Records, and Clinical Operations.
9. Serves as a group leader by performing one or more of the following duties:10. Employee training 11. Routing work assignments 12. Participation in employment-related issues
10. Reviews requested adjustments from Specialists and approves low-dollar adjustments within policy guidelines. Collects information and supporting documentation for Director approval of high-dollar adjustments.
11. Performs testing and monitoring of new system logic and processes with the Business Analyst and/or Manager.

Other Duties:

1. Answers phone calls and correspondence, providing requested information to assist in resolving account balances.
2. Maintains knowledge of and performs duties in compliance with Guthrie Medical Group and payer guidelines.
3. Provides feedback related to workflow processes to promote efficiency.
4. Utilizes Epic system functions accurately to perform assigned tasks, including:
5. Charge corrections
6. Invoice inquiries
7. Credits
8. Charge review
9. Claim edits
10. 277 rejections
11. Related billing functions Trains staff on these functions as needed.
12. Demonstrates excellent customer service skills for both internal and external customers while promoting the same within the team environment.
13. Maintains strict confidentiality of patient health information in accordance with HIPAA regulations.
14. Assists with and completes special projects and other duties as assigned.