RCM Specialist

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 Revenue Cycle Specialist is responsible for a wide range of revenue cycle processes. The individual will need to have expertise in medical coding and insurance billing as well as a strong understanding of insurance reimbursement processes and regulations. The successful candidate will work closely with RCM leadership, patients, physicians, and insurance companies to ensure that accurate and timely billing is completed.

Responsibilities:

• Confirm insurance benefits and eligibility for patients as required

• Request authorizations from payers for radiation therapy and imaging services as required

• Reviews and understands the reasons for authorization denials and completes the appropriate steps/actions to correct submission errors, and/or submit upfront appeals to the payer for authorization approvals

• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.

• Communicate with patients and families about the status of pre-authorization and appeals for radiation therapy treatments, including providing education about insurance coverage and benefits

• Review and enter Radiation Oncology and Imaging charges into practice management system

• Audit charges and communicate outstanding charges and/or questions with clinical staff.

• Ensures that claims for all services rendered are submitted to the payers within the timely filing guidelines of each individual payer with minimal errors

• Communicate openly with Clinical staff and RCM teams to ensure timely and accurate billing is completed

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

• Work assigned Unity tasks daily to resolve any tasks identified by ACE edits, rejections, denials, collectors or other RCM teams

• Identify and work tickets to resolution in various statuses within the Practice Management system daily

• Ability to review, interpret and apply knowledge of billing guidelines and medical policies

• Train with team members or other employees when assigned by management

• Maintains a complete understanding of HCPCS/ICD/CPT oncology coding and specific carrier requirements/knowledge

• Recognizes problems or trends and provides suggestions to help find resolutions

• Delivers timely responses to emails and telephone messages as appropriate

• Keeps informed of current industry trends, coding regulations, changes to insurance policies, and other developments impacting the field of radiation therapy and radiology and effectively communications and applies this knowledge

• Follows policy and procedures outlined by management to ensure standardization of processes

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

Essential Competencies:

• Attendance is an essential job function.

• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.

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

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

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

• Strong analytical skills and ability to meet assigned deadlines

• Strong knowledge of Windows-based applications (Word, Outlook, Excel, etc)

• Ability to operate various types of office equipment.

• Must possess high degree of professionalism and adaptability.

Required Qualifications:

• High School diploma or equivalent required

• Bachelor’s degree preferred.

• Previous experience in Charge Entry, Billing or Coding required, preferably in an Oncology healthcare setting

• Radiation Oncology/Proton experience a plus

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

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