Claims Resolution Specialists II

American Oncology Network, Inc.; Macon (GA); On-site; USD 22,000 - 36,000; Full time

Job summary

American Oncology Network is seeking a claims/billing specialist to review medical insurance claims for resolution and obtain appropriate payments. You will respond to inquiries, denials, and correspondence from various entities to secure timely payments.

Role requires 1 year in medical billing/collections, strong knowledge of ICD-9/ICD-10/CPT codes, EOBs, and EMR experience (Centricity preferred). You will work across multiple departments, ensuring HIPAA compliance and accurate patient

Qualifications

• High School diploma or GED required.
• At least 1 year of prior work experience in the medical field, as well as experience in medical billing and/or collections.
• Must have excellent knowledge of insurance carrier billing and reimbursement with knowledge of medical terminology, ICD-9, ICD-10 and CPT codes.
• Must have an in-depth understanding of explanation of benefits (EOB).
• Electronic Medical Records (EMR), GE Centricity Practice Management software experience preferred.
• Employee must be knowledgeable in Medical Oncology/Hematology and/or Radiation, Pathology, Radiology, Pumps and Specialties.
• Excellent communication and interpersonal skills are required.
• Employee must be able to work independently as well as in a team.
• Employee must complete 6 CEUs annually.

Responsibilities

• Apply billing/collection knowledge required for insurance payers to insure proper and maximum reimbursement.
• Respond to patient and office inquiries regarding outstanding insurance balances, insurance payments received, allowable charges, assignment of benefits and any other insurance questions.
• Manage insurance review and denial of payment by responding with appropriate documentation to support appeal.
• Follow-up on claim to ensure payment was received.
• Coordinate effort with office personnel and/or the doctor as necessary.
• Report any consistent claim denials or problems to appropriate team lead per payer.
• Inquire about and resolve any payments that differ from established profile on our payer contracts.
• Attend third party payer meetings, seminars, and training sessions and report any changes or concerns to your supervisor.
• Follow-up on correspondence in a timely manner.
• Transfer appropriate balances to patient responsibility per SOP and notify the patient and appropriate department of this action accordingly.
• Bill applicable secondary insurance.
• Document all collection activity in Onco EMR, Centricity and Unity.
• Contact patients to correct insurance information to ensure accuracy as needed.
• Maintain and ensure the confidentiality of all patient and employee information at all times as established by HIPPA and Company policies.
• Keep work area and records in a neat and orderly manner.
• Maintain all company equipment in a safe and working order.
• Will be expected to work at any Company location to help meet the Company's business needs.
• Must establish and maintain effective work relationships with new and existing customers through a high degree of professionalism and excellent interpersonal communication skills.
• Will be expected to complete additional reports or projects as assigned by management.
• Comply with all Federal and State laws and regulations pertaining to patient care, patients' rights, safety, billing, human resources and collections.
• Adhere to all Company and departmental policies and procedures, including IT policies and procedures and Disaster Recovery Plan.

Skills

Excellent communication

Team player

Independent worker

Attention to detail

Medical terminology

HIPAA knowledge

CEU compliance

Education

High School diploma or GED

Tools

GE Centricity Practice Management

Job description

Location: Central Georgia Cancer Care

Pay Range: $15.83 - $26.38

Position Summary

Review medical insurance claims for resolution and to obtain appropriate payment thru outlined processes. Resolve incoming inquiries, denials and correspondence from various entities to obtain appropriate resolution and payment in timely manner. Contact insurance carriers to research, compile and respond on open account balances to obtain appropriate payments.

Required Qualifications

• High School diploma or GED required.
• At least 1 year of prior work experience in the medical field, as well as experience in medical billing and/or collections.
• Must have excellent knowledge of insurance carrier billing and reimbursement with knowledge of medical terminology, ICD-9, ICD-10 and CPT codes.
• Must have an in-depth understanding of explanation of benefits (EOB).
• Electronic Medical Records (EMR), GE Centricity Practice Management software experience preferred.
• Employee must be knowledgeable in Medical Oncology/Hematology and/or Radiation, Pathology, Radiology, Pumps and Specialties.
• Excellent communication and interpersonal skills are required.
• Employee must be able to work independently as well as in a team.
• Employee must complete 6 CEUs annually.

Key Performance Areas

• Apply billing/collection knowledge required for insurance payers to insure proper and maximum reimbursement.
• Respond to patient and office inquiries regarding outstanding insurance balances, insurance payments received, allowable charges, assignment of benefits and any other insurance questions.
• Manage insurance review and denial of payment by responding with appropriate documentation to support appeal.
• Follow-up on claim to ensure payment was received.
• Coordinate effort with office personnel and/or the doctor as necessary.
• Report any consistent claim denials or problems to appropriate team lead per payer.
• Inquire about and resolve any payments that differ from established profile on our payer contracts.
• Attend third party payer meetings, seminars, and training sessions and report any changes or concerns to your supervisor.
• Follow-up on correspondence in a timely manner.
• Transfer appropriate balances to patient responsibility per SOP and notify the patient and appropriate department of this action accordingly.
• Bill applicable secondary insurance.
• Document all collection activity in Onco EMR, Centricity and Unity.
• Contact patients to correct insurance information to ensure accuracy as needed.
• Maintain and ensure the confidentiality of all patient and employee information at all times as established by HIPPA and Company policies.
• Keep work area and records in a neat and orderly manner.
• Maintain all company equipment in a safe and working order.
• Will be expected to work at any Company location to help meet the Company's business needs.
• Must establish and maintain effective work relationships with new and existing customers through a high degree of professionalism and excellent interpersonal communication skills.
• Will be expected to complete additional reports or projects as assigned by management.
• Comply with all Federal and State laws and regulations pertaining to patient care, patients' rights, safety, billing, human resources and collections.
• Adhere to all Company and departmental policies and procedures, including IT policies and procedures and Disaster Recovery Plan.

About American Oncology Network (AON)

#AONA #LI-ONSITE American Oncology Network AON is an alliance of physicians and veteran healthcare leaders dedicated to ensuring the long-term success and viability of oncology diagnosis and treatment in community-based settings. It is the fastest growing national network of community oncology practices delivering local access to exceptional cancer care.

AON serves its expanding network of partner practices by providing proven practice management expertise. Our employees across the country work together to empower physicians to make cancer care better. By driving integrated, collaborative care, we are proudly helping community oncologists deliver the highest quality care to every patient. Cancer touches everyone. Being able to make a difference in the lives of those fighting this disease is something our employees at AON cherish and never take for granted.

A career in oncology offers all sorts of rewards. But working at AON offers employees more than most. As a fast-growing national company, the opportunity to join a national workforce with flexible work options is available. We offer competitive compensation packages that include comprehensive health insurance with a robust provider network. Our 401k, which offers a 100% match and investment options, is available to full-time and part-time staff members, and we feature a generous Paid Time Off (PTO) program. At AON, we offer you more than a job, we offer you a career.

As a network of independent oncology practices working together as one, we host annual summits each year, providing our employees a chance to collaborate with AON peers from across the country. Promoting from within is a priority at AON, and we support our team members continued growth through professional development programs and tuition assistance.

At AON, we offer you more than a job, we offer you a career. As a network of independent oncology practices working together as one, we host annual summits each year, providing our employees a chance to collaborate with AON peers from across the country. Promoting from within is a priority at AON, and we support our team members continued growth through professional development programs and tuition assistance.