Claims Resolution Specialist II - Medical Billing & Denials

American Oncology Management Company; Macon (GA); On-site; USD 2,181,000 - 3,634,000; Full time

Job summary

American Oncology Management Company seeks a claims specialist to review medical insurance claims and secure timely payment. You will handle inquiries, denials, and correspondence from insurers to maximize reimbursement and keep accounts current.

The role requires knowledge of medical terminology, ICD-9/ICD-10, CPT codes, EMR systems, and strong communication. Oncology/radiology exposure and CEU requirements support growth.

Qualifications

• High School diploma or GED required.
• At least 1 year of prior work experience in the medical field, with medical billing/collections.
• Strong knowledge of medical billing, reimbursement, and clinical terminology (ICD-9/10, CPT).
• EMR experience; GE Centricity Practice Management preferred.
• Experience in Oncology/Hematology, Radiation, Pathology, Radiology, Pumps is a plus.
• Excellent communication and interpersonal skills; able to work independently.
• Completes 6 CEUs annually.

Responsibilities

• Apply billing and collection knowledge to maximize insurance reimbursement.
• Respond to inquiries about outstanding balances, payments, and allowable charges.
• Research denials and prepare documentation to support appeals; follow up to ensure payment.
• Notify supervisor of consistent denial issues per payer; coordinate with staff/physician as needed.
• Resolve discrepancies with payer contracts and established profiles.
• Attend payer meetings and training; report changes to supervisor.
• Document all collection activity in EMR systems and ensure patient information accuracy.
• Maintain confidentiality per HIPAA and company policies.
• Keep work area organized and ensure equipment is maintained.
• Work at multiple company locations to meet business needs.
• Build professional relationships with customers and provide timely reports.

Skills

Medical billing

Medical collections

Insurance payer research

EOB knowledge

ICD-9/ICD-10/CPT codes

EMR systems

Communication skills

Independent worker

HIPAA compliance

Education

High School diploma or GED

Tools

GE Centricity Practice Management

Job description

American Oncology Management Company seeks a claims specialist to review medical insurance claims and secure timely payment. You will handle inquiries, denials, and correspondence from insurers to maximize reimbursement and keep accounts current.

The role requires knowledge of medical terminology, ICD-9/ICD-10, CPT codes, EMR systems, and strong communication. Oncology/radiology exposure and CEU requirements support growth.