Claims Resolution Specialists II

American Oncology Network; Macon (GA); On-site; USD 37,000 - 58,000; Full time

Job summary

American Oncology Network is seeking a Medical Billing Specialist to review insurance claims, resolve inquiries and denials, and secure timely payments. You will liaise with insurance carriers to research balances and respond with supporting documentation, following SOPs and HIPAA rules.

The role requires 1 year in medical billing/collections, CPT/ICD code knowledge, and EMR proficiency (GE Centricity preferred). On-site in Central Georgia with a competitive pay range.

Qualifications

• High school diploma or GED required.
• At least 1 year of medical billing/collections experience.
• Strong knowledge of insurance billing and CPT/ICD codes.
• In-depth understanding of explanation of benefits (EOB).
• Experience with EMR systems, GE Centricity preferred.
• Knowledge of Oncology/Hematology or related imaging/specialties.
• Excellent communication and interpersonal skills.
• Ability to work independently or in a team; adhere to HIPAA.

Responsibilities

• Maximize reimbursements through accurate billing and collections.
• Respond to inquiries about outstanding balances and payments.
• Manage claim denials with documentation to support appeals.
• Coordinate with office staff and clinicians as needed.
• Report recurring denials or issues to the payer and supervisor.
• Address contract discrepancies and follow SOPs.
• Attend payer meetings and trainings as required.
• Document all collection activity in EMR systems.
• Maintain patient confidentiality per HIPAA and company policies.

Education

High School Diploma or GED

Tools

Centricity Practice Management

Onco EMR

Unity

Job description

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.

Location

Central Georgia Cancer Care

Hiring Range

$18.00 - $28.08

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.