Insurance Specialist II - Corporate Patient AR Mgmt - Full Time

Guthrie; Sayre (Bradford County); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare organization in Bradford County, Sayre is seeking an experienced Insurance Specialist II to oversee complex billing tasks and train new staff. The role involves analyzing denials, preparing appeals, and collaborating with various departments to streamline claim submissions. Ideal candidates will have at least 3 years of experience in insurance billing and excellent customer service skills. This is a full-time position with competitive benefits.

Qualifications

• Minimum of 3 years’ experience in insurance billing or CPC certification.
• Demonstrated competence in independent performance and teamwork.
• Self-motivated with knowledge of insurance regulations.

Responsibilities

• Analyze complex billing problems and prepare appeals.
• Identify and evaluate denials for assigned payers.
• Train and guide staff on protocols and workflows.

Skills

Strong organizational skills

Customer service skills

Knowledge of medical terminology

CPT and ICD-10 coding knowledge

Ability to work in a high-volume environment

Education

High school diploma or equivalent

CPC, CCA, RHIA, RHIT certification preferred

Associate’s degree preferred

Tools

Epic system

Job description

Insurance Specialist II – Corporate Patient AR Management (Full Time)

Position summary: This role fulfills all responsibilities of an Insurance Specialist I and includes additional leadership duties. The Specialist serves as a resource within the department and trains Insurance Billing Specialists I and other support staff. The Specialist collaborates with the Director, Manager, Supervisor and Application Analyst on day‑to‑day priorities, maintaining a high level of integrity throughout the unit. Responsibilities include completing complex insurance billings and appeals, reviewing procedures to identify problem areas, preparing reports, working with payers on problem claims, and resolving outstanding accounts receivable and credit balances.

Education and Certification

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

Experience and Qualifications

• Minimum of 3 years’ experience in insurance billing or CPC certification. • Demonstrated competence in performing required tasks independently, contributing to a team environment, and maintaining knowledge of medical terminology, CPT and ICD‑10 coding, and insurance regulations. • Strong organizational and customer‑service skills. • Proven ability to thrive in a high‑volume, fast‑paced environment and self‑motivate to develop and maintain job knowledge.

Essential Functions

1. Identify and evaluate denials for assigned payers and/or specialties, determine issues and patterns, and develop action plans to reduce denials and streamline claim submissions as part of the Denial Task Force.
2. Export data, prepare spreadsheets, and run reports to resolve outstanding claims, identify trends, and provide follow‑up for claims requiring correction or appeal.
3. Analyze complex billing problems, prepare appeals, challenge payer policies, and pursue appeal turnover when necessary.
4. Collaborate with team and department management to develop and train internal rejection protocols, staying current with coding knowledge, reimbursement policies, payer guidelines, and other relevant sources.
5. Ensure staff adherence to protocols through audit and education.
6. Report and resolve payer, system, or billing issues, and provide recommendations for resolution.
7. Work with team and payers to ensure timely resolution of credit balances and prepare annual escheatment documentation.
8. Lead payer‑specific external claim audit activities in collaboration with Management, Compliance, Medical Records, and Clinical Operations.
9. Perform group‑leader duties including employee training, routing work assignment, and participating in employment issues.
10. Review requested adjustments from Specialists, approve low‑dollar adjustments within policy guidelines, and gather documentation for high‑dollar adjustment approval.
11. Test and monitor new system logic or processes with Business Analyst and/or Manager.

Other Duties

1. Answer phone calls and correspondence to provide requested information for resolution of account balances.
2. Maintain knowledge and comply with Guthrie Medical Group and payer guidelines.
3. Provide workflow feedback to promote efficiency.
4. Utilize Epic system functions accurately for assigned tasks, including charge corrections, invoice inquiries, credits, charge reviews, claim edits, and 277 rejections, and train staff as needed.
5. Demonstrate excellent customer service skills for internal and external customers while fostering the same within the team.
6. Maintain strict confidentiality of patient health information in accordance with HIPAA.
7. Assist with and complete projects and other duties as assigned.

Job Information

Seniority level: Mid‑Senior level
Employment type: Full‑time
Job function: Other
Industries: Hospitals and Health Care