Medical Coding and Billing 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:

Role Summary: 

The Medical Coding and Billing Specialist is responsible for writing and maintaining coding and billing rules in the practice management system. The position is also responsible for reviewing and importing daily charges in Radiology Authorization Specialist and daily claim filing. Excellent verbal and written communication skills required. The coding and billing works under the direct supervision of their respective team manager.   

Responsibilities:  

• Review and verify patient insurance coverage and eligibility for proton therapy treatments.  

• Verify all applicable charges for proton therapy, radiation therapy, and radiology services are entered timely and accurately into the practice management system for reimbursement.  

• Generate and submit accurate and timely claims for proton therapy, radiation therapy, and radiology services to insurance payers.  

• Monitor and track claims through the billing process to ensure timely payment and identification of payer roadblocks.  

• Assist with investigation and resolution of any claim rejections, denials, or appeals related to proton therapy treatments.  

• Review and interpret insurance policies and regulations related to proton therapy treatments to ensure compliance with billing requirements.  

• Work collaboratively with the proton therapy center's medical and pre-authorization teams to ensure accurate and complete billing for proton therapy and radiation therapy treatments  

• Maintain accurate and up-to-date records of billing activities in patient files and computer systems  

• Ability to review and interpret radiation oncology medical records for accuracy as it relates to coding and billing.  Educate clinical team on appropriate documentation requirements.  

• Assist team members with responses to patient and insurance company inquiries about billing for proton therapy treatments in a timely and professional manner  

• Stay current with industry trends, changes to insurance policies, and other developments that may impact the billing process for proton therapy and radiation therapy treatments.  

• Review and verify patient insurance coverage and eligibility for proton therapy treatments as needed.  

• Reviews charges in “Approve Failed” status daily for accuracy and corrective action.