AR Representative, Oncology

Triarq Practice Services; Royal Oak (MI); Vor Ort; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

TRIARQ Health is seeking an experienced Oncology AR Representative to recover oncology and infusion claims for our practice clients. You will handle high-dollar drug and administration claims, understand J-codes, NDCs, and infusion hierarchies, and explain a denial and fix it the first time.

You’ll report to the RCM Client Success Manager and partner to keep client receivables healthy, identifying payer trends before they create backlogs.

Qualifikationen

• 2+ years combined insurance AR and healthcare revenue cycle experience.

Aufgaben

• Manage oncology AR including denials, rejections, underpayments and no-response claims.
• Resolve J-code, NDC billing, units/dosage conversions, JW/JZ modifiers.
• Research and resolve medical necessity, authorization, and coverage denials.
• Prepare and submit corrected claims, reconsiderations, and appeals.
• Use payer portals, IVR, and follow up to move accounts to resolution.
• Update incomplete or inaccurate account information.
• Write clear follow-up notes on every touched account.
• Report issues to the Client Success Manager with actionable insights.
• Spot denial trends and suggest process improvements.

Kenntnisse

Insurance AR

Oncology AR

CPT/HCPCS

ICD-10-CM

Payer portals

Excel

Attention to detail

Problem solving

Tools

Excel

Jobbeschreibung

Description

Oncology AR Representative

Reports to: RCM Client Success Manager

Department: Revenue Cycle Management

About the Role

TRIARQ Health is looking for an experienced insurance receivables professional to recover oncology and infusion claims for our practice clients. You'll work high-dollar drug and administration claims where detail matters. You'll know how payers adjudicate J-codes, NDCs, and infusion hierarchies, and you'll be able to explain a denial and fix it the first time. This role fits someone who likes a fast-paced production setting, takes pride in accuracy, and picks up new technology quickly.

You’ll report to the RCM Client Success Manager. You’ll be their partner in keeping client receivables healthy, and you’ll raise payer trends before they turn into backlogs.

Key Responsibilities

• Work assigned oncology AR, including denials, rejections, underpayments, and no-response claims, using TRIARQ's denial management workflow and proprietary workflow tools.
• Resolve drug and infusion claim issues: J-code and NDC billing, units and dosage conversions, JW/JZ modifier requirements, infusion and injection hierarchy (initial, sequential, and concurrent administration), and hydration billing.
• Research and resolve medical necessity, authorization, and coverage denials, using payer policies, LCDs and NCDs, and the documentation that supports the claim.
• Prepare and submit corrected claims, reconsiderations, and appeals with complete supporting documentation, within payer timely filing and appeal deadlines.
• Use payer portals, IVR, and phone follow‑up to get claim status and move accounts to resolution. Work with insurance representatives tactfully and persistently.
• Find and update incomplete or inaccurate account information, including demographics, eligibility, coordination of benefits, and authorization numbers.
• Write clear, complete follow‑up notes on every account touched, so anyone picking up the account knows its status and next step.
• Report clinical documentation questions, coding issues, and recurring payer problems to the Client Success Manager. Communicate them in a way that helps the practice fix the cause.
• Spot denial trends by payer, drug, or CARC/RARC, and recommend process changes that prevent repeat denials.

Key Results

• 120+ day receivables go down and stay within company and client targets.
• Denials and rejections are worked within established turnaround times, with issues resolved in an average of 48 hours.
• Daily and monthly productivity goals are met or exceeded at 98% accuracy or higher.
• High‑dollar drug claims are prioritized and followed through to payment or final resolution.
• Account notes are audit‑ready and give a clear picture of each claim’s status.
• You represent multiple practices professionally and consistently, and communicate clearly with your Client Success Manager, peers, and client staff.

What Success Looks Like

At 90 days, you’ll be working a full assigned oncology AR queue at target productivity and accuracy. You’ll know each client’s main payers, and you’ll be sending your Client Success Manager useful denial trends that help shape client conversations and prevention work.

Requirements

Qualifications

Required

• 2+ years of combined insurance AR and related healthcare revenue cycle experience
• 1+ year of oncology insurance billing or AR experience
• 1+ year of drug infusion and administration AR experience
• Working knowledge of CPT, HCPCS (J-codes), ICD-10-CM, and CARC/RARC denial codes
• Fluency with payer websites and portals, including Medicare, Medicare Advantage, Medicaid, and commercial payers
• Solid Microsoft Office skills, especially Excel
• Strong problem solving and attention to detail
• Comfortable with technology and eager to learn new systems

Preferred

• Experience with buy-and-bill drug claims and payer drug policies
• Familiarity with oncology prior authorization requirements and pathways programs
• Experience with patient assistance programs and manufacturer copay programs as they relate to balance resolution
• Experience supporting multiple practices or clients in a billing company or RCM service setting
• CPC, CPB, or CRCR certification, or similar