Senior Revenue Integrity Analyst

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:

The Senior Revenue Integrity Analyst role reviews claim reimbursement to ensure accuracy to contractual guidelines and payer fee schedules across multiple Oncology practices across multiple states. Responsible for analysis, trending, system setup and corrections, and payer escalation in conjunction with practice leadership. The individual will need to have expertise in medical billing, as well as a strong understanding of the insurance reimbursement and contracting processes. This will be a remote role.  

Responsibilities 

• Load and/or maintain practice contracts in our insurance reimbursement tracking tool.  

• Validate contract modeling and setup opportunities as needed, in collaboration with external partners.  

• Identify erroneous payer trends and escalate payer reimbursement issues and contracting concerns to leadership, as needed.  

• Contact payers on high dollar individual escalations or high priority payer issues.  

• Organize and coordinate individual claim resolution with practice team and other partners.  

• Work with other members of the RCM team to ensure proper resolution and timely payment.  

• Maintain a thorough understanding of HCPCS/ICD/CPT oncology coding and specific carrier requirements/knowledge.  

• 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 insurance reimbursement and contract analysis required, preferably in an Oncology healthcare setting. 

• 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