Contract Adherence Specialist

Astera Cancer Care; Northern (KY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

OneOncology is seeking a Contract Adherence Specialist to manage fee schedule data, secure and audit contracted rates, and help resolve underpayments for payer reimbursements. The role emphasizes accuracy, documentation, and data analysis to support independent physicians within a physician-driven, technology-powered model.

Ideal candidates bring strong billing knowledge, CPT/HCPCS expertise, and several years in healthcare accounts receivable, with a focus on revenue cycle processes and timely

Qualifications

• High School diploma or equivalent required.
• Minimum five years in accounts receivable, healthcare, or managed care preferred.

Responsibilities

• Manage and audit contracted fee schedules for accuracy.
• Identify and resolve underpayment issues across payers.
• Perform audits and compile data for recovery efforts.
• Maintain payer reimbursement documentation and spreadsheets.
• Research payment discrepancies and manage underpayment appeals.

Skills

Billing procedures

CPT/HCPCS coding

Revenue cycle knowledge

Data accuracy and auditing

Analytical skills

Microsoft Office (Excel/Word)

Education

High School diploma or equivalent

Job description

Why join us?

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision. This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description

Role Summary: The Contract Adherence Specialist will be responsible for managing and maintaining fee schedule related aspects of Payer Reimbursement, including securing, loading, and auditing contracted fee schedule data for accuracy. In addition, this position will assist in identifying and resolving underpayment related issues for all applicable payers.

Responsibilities

• Knowledgeable and proficient in Claims billing procedures CPT and HCPCS codes


• Demonstrates and applies expert level of knowledge of revenue cycle processes and concepts


• Interpret contract reimbursement


• Maintains documentation for contractual reimbursement for payers.


• Maintains data in appropriate database


• Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.


• Performs account audits


• Manages payer log spreadsheets to be submitted to the health plans.


• Identify trends in underpayments


• Research and identify payment discrepancies from various sources


• Performs reviews and assessments for underpaid claims


• Compile and analyze data for recovery


• Manage underpayment appeals and account follow-up


• Resolve underpaid claims in an effective and timely fashion


• Reports dollars and recovery efforts routinely to management

Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications

• High School diploma or equivalent required


• Minimum five (5) years’ experience in accounts receivable, healthcare, or managed care preferred

Essential Competencies

• Attendance is an essential job function.


• Detailed knowledge of billing, HCPCS, CPT and ICD codes.


• Previous collections experience preferred


• Exceptional Multi-tasking, organizational skills and attention to detail


• Works well under deadlines and time sensitive projects while maintaining accuracy


• Strong numeric and analytical skills


• Self-motivated, able to work autonomously, multi-task and switch focus quickly


• Excellent verbal and written communication skills


• Strong knowledge of Windows-based software applications (E.g. Word, Excel, Outlook, Access)


• Must possess high degree of professionalism and adaptability.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.

OneOncology was founded by community physicians, for community physicians, with the mission of improving the lives of everyone living with cancer and other diseases. Our goal is to enable community medical practices to remain independent and to improve patient access to care in their communities, all at a lower cost than in the hospital setting. OneOncology supports our platform of community medical practices through group purchasing, operational optimization, practice growth, and clinical innovation. Our partner practices comprise approximately 2,300+ providers who care for approximately 1.5 million patients across 20 states.