Insurance AR Specialist

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

This Insurance AR Specialist reviews monthly accounts receivables, follow up for resolution, insurance contact and claim re-files when necessary. Responsible for all aspects of insurance management of assigned payers including follow-up, research, and problem resolutions. The individual will need to have expertise in medical billing and collections, as well as a strong understanding of insurance reimbursement processes and regulations related to one or more of the specialties including, medical oncology, radiation therapy, radiology services and multi-specialty procedures. The successful candidate will work closely with patients, practices, and insurance companies to ensure that accurate and timely payments are received, and outstanding balances are collected.

Responsibilities:

· Acts as an escalation resource for team members that perform first pass analysis of denials and claims with no payer response.

· Reviews the denial trending with the team to identify upstream opportunities for process improvement.

· Communicates with payers, practices and other RCM teams to resolve complex issues or to correct a process that is causing denials.

· Reviews write-off requests to evaluate the root cause of the failed collection efforts.

· Advises supervisor of any unusual payer denial or underpayment scenarios.

· Preforms quality audits on the team members performing first pass analysis of denials and claims with no payer response.

· Works with other departments to gather necessary information for proper account work/collection activity.

· Maintains a complete understanding of HCPCS/ICD/CPT coding and specific carrier requirements/knowledge for the specialty they are assigned.

· Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications:

· High school diploma or equivalent required

· Bachelor’s degree preferred

· Minimum of 3 years of experience in medical collections required, preferably in an Oncology or

multi-specialty healthcare setting

· Medical or Radiation Oncology experience a plus

· Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid

Essential Competencies:

· Attendance is an essential job function.

· Detailed knowledge of billing, HCPCS, CPT and ICD codes

· Previous commercial collections experience preferred

· Ability to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment and customer service orientation.

· Effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.

· Exceptional Multi-tasking, organizational skills and superb attention to detail.

· Strong analytical skills

· Skill in negotiating issues and resolving problems.

· Excellent customer service skills.

· Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient billing and other medical information systems.

· Ability to operate various types of office equipment.

· Must possess high degree of professionalism and adaptability.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.