[Hiring] AR Medical Insurance Specialist Lead @The US Oncology Network

Role Description

The US Oncology Network is looking for an upbeat and ambitious Remote Insurance Specialist Lead. US Oncology is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes!

Come join our team in the fight against cancer!

SCOPE

• With little or no supervision, monitors the revenue cycle work load and reassigns work as necessary to meet deadlines.
• Performs all revenue cycle job responsibilities as needed to meet deadlines.
• Utilizes broad range of knowledge including operating procedures, policies, regulations, and systems to accomplish responsibilities.
• A certain degree of creativity and latitude is required.
• Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology’s Shared Values.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Directs the revenue cycle work load of co-workers including auditing work for accuracy and completeness, re-assigning work, and establishing priorities.
• Reviews reports to verify that collection and billing submission tasks are completed and deadlines are met.
• Provides procedure guidance and direction to co-workers.
• May research, resolve, or provide direction on co-workers’ escalated issues.
• Trains co-workers on policies and procedures.
• Verifies existing patients have necessary referral and/or authorization documentation prior to examination date.
• Contacts and follows up with patient’s physician for any missing or incomplete documentation.
• Spot checks patient charts for completeness.
• Contacts clinical staff for clarification on procedures or diagnosis and on missing information.
• Reviews reports for claim denials and works with co-workers on status and problem resolution.
• Reviews payment postings for accuracy and to ensure account balances are current.
• Performs detailed account reconciliation to resolve issues.
• Codes, processes, and submits insurance claims to third party payor.
• Identifies and reports any payer trends, denial patterns, and delays to management and recommends write-offs.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records.
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations.
• Proactively identifies revenue cycle process and procedure gaps and develops tools to improve efficiencies.
• Maintains and updates the Practice’s revenue cycle Standard Operating Procedures (SOPs).
• Trains coworkers on revenue cycle policies and procedures.
• May develop training materials and tools.
• Performs other duties as requested or assigned.

Qualifications

• High School diploma or equivalent required, Associates degree preferred.
• Minimum two (2) years insurance resolution experience resolving issues with patients and payors as well as four (4) years combined automated medical billing and payment experience required.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.
• Demonstrate knowledge of oncology medical coding required.
• Demonstrate knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures.
• Demonstrate knowledge of state, federal, and third party claims processing required.
• Demonstrate knowledge of state and federal collections guidelines required.
• Must successfully complete required e-learning courses within 90 days of occupying position.

Requirements

• Uses Technical and Functional Experience.
• Possesses up to date knowledge of the profession and industry.
• Is regarded as an expert in the technical/functional area.
• Accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability.
• Handles day to day work challenges confidently.
• Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change.
• Shows resilience in the face of constraints, frustrations, or adversity.
• Demonstrates flexibility.
• Uses Sound Judgment.
• Makes timely, cost effective, and sound decisions.
• Makes decisions under conditions of uncertainty.
• Shows Work Commitment.
• Sets high standards of performance.
• Pursues aggressive goals and works efficiently to achieve them.
• Commits to Quality.
• Emphasizes the need to deliver quality products and/or services.
• Defines standards for quality and evaluates products, processes, and services against those standards.
• Manages quality.
• Improves efficiencies.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is required to be present online during regularly scheduled business hours.
• Regularly required to sit or stand and talk or hear.
• The position requires full range of body motion manual and finger dexterity, and eye-hand coordination.
• The position requires sitting for extensive periods of time.
• The employee occasionally lifts and carries items weighing up to 40 lbs.
• The position requires corrected vision and hearing to normal range.

Work Environment

Work will involve online interaction with co-workers and management and/or clients. Work may require minimal travel.