Insurance Claims Resolution Specialist

US Oncology Inc.; Antioch (CA); On-site; USD 33,000 - 44,000; Full time

Job summary

US Oncology Inc. is seeking an Insurance Follow-Up Specialist to investigate aged insurance claims, determine payment status, and drive timely resolutions. You will work with EPIC EMR, DoFR processes, and health plan contacts to rebill, adjust, and appeal claims within carrier filing limits.

The role emphasizes strong documentation, collaboration with supervisors, and maintaining spreadsheets; you will target 35-40 claims per day on average and support process improvements.

Qualifications

• High School diploma or equivalent required.
• 2 Years - Business Admin / Healthcare / Related Field preferred.
• Certified Medical Reimbursement Specialist CMRS preferred.
• Certified Medical Insurance Specialist CMIS preferred.
• 1-2 years Billing in Medical Office / Hospital required.
• 1-2 years CPT/ICD-10 guidelines and use of modifiers required.
• 1 year Excel and other Microsoft office applications required.
• 1-year EMR knowledge required.
• 1-2 years EPIC EMR preferred.
• 1-2 years Division of financial responsibility (DoFR) experience and training capability preferred.

Responsibilities

• Insurance follow up experience- Multi specially preferred
• Maintains timely follow-up on outstanding insurance claims in appropriate EPIC WQs (Work Queues), ensuring claims are billed/rebilled within carrier filing limits
• Effectively takes appropriate action on claim denials to ensure prompt resolution and follows-up on those rebilled, corrected and appealed
• Maintains detailed documentation in software system(s) of all claims & collections activities, including rebills, all follow-up, and related correspondence with carriers, practitioners
• Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues
• Informs Supervisor of problems related to insurance company payments/denials, contract pricing, and works with Supervisor and all parties involved to ensure prompt resolution
• Strong MS Office capabilities to include Word, Excel, and Outlook
• Demonstrated ability to work well in a team environment, follow protocol and workflows.
• Ability to multi-task in a fast-paced work setting, with multiple technology platforms.
• Meets daily A/R target of 35-40 claims daily (on average)
• Work collaboratively with leadership and other team members to improve or challenge processes, provide trending and solutions insights, and support the capability development of the team
• Will be responsible for maintaining spreadsheets assigned by Supervisor

Skills

Microsoft Office

EPIC EMR

DoFR experience

Medical billing

Education

High School diploma or equivalent

Certified Medical Reimbursement Specialist CMRS

Certified Medical Insurance Specialist CMIS

Tools

Excel

Job description

US Oncology Inc. is seeking an Insurance Follow-Up Specialist to investigate aged insurance claims, determine payment status, and drive timely resolutions. You will work with EPIC EMR, DoFR processes, and health plan contacts to rebill, adjust, and appeal claims within carrier filing limits.

The role emphasizes strong documentation, collaboration with supervisors, and maintaining spreadsheets; you will target 35-40 claims per day on average and support process improvements.