Claims Resolution Specialists II

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

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.