Insurance Credits Specialist

Astera Cancer Care; Nashville (TN); On-site; USD 42,000 - 62,000; Full time

Job summary

OneOncology is seeking a detail‑driven Billing Specialist to evaluate credit balances and refund requests. The role requires coordination of benefits and accurate payment audits, with responsibility for preparing refund requests for approval and issuing payments or credits as needed.

Ideal candidates will have a year of medical billing experience, proficiency in CPT/HCPCS/ICD codes, strong communication skills, and solid MS Office usage.

Qualifications

• High School diploma or equivalent required.
• One year of billing-related experience preferred.
• Detailed knowledge of billing, HCPCS, CPT and ICD codes.
• Strong verbal and written communication skills.
• Proficient in MS Office and basic computer applications.

Responsibilities

• Evaluate daily credit balances created at payment posting.
• Research credits/refund requests to determine appropriate overpaid party.
• Prepare refund requests for approval and assist with check issuance or payer offset.
• Maintain batch files of completed requests and ensure correct processing of overpayments.
• Identify posting issues related to credit balances and inform Team Leader for audit purposes.
• Evaluate refund/overpayment requests and respond by refunding or disputing as needed.
• Transfer money when necessary via Issue Assistance.
• Refer to managed care profiles and AWP grids to determine legitimate credits.
• Coordinate with other departments to resolve credit balances or refunds.
• Complete a daily task log and submit to Team Leader monthly.

Skills

Medical billing

CPT/HCPCS/ICD coding

Attention to detail

Communication skills

MS Word, Excel, Outlook

Customer service

Education

High School diploma or equivalent

Tools

Excel

Outlook

Patient billing systems

Job description

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.Why join us? 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:This role is responsible for evaluating credit balances, preparing and/or disputing refund requests. This position requires in-depth coordination of benefits (COB) knowledge of rules pertinent to making order of benefit determinations, strong attention to payment detail, and good interpretive skills.Responsibilities:Evaluate daily credit balances which are created at the time of payment posting.Research credits/refund requests to determine the appropriate overpaid party.Prepare refund requests for approval and check issue by Accounts Payable or for offset by payer.Maintain batch files of completed requests, review to ensure overpayment has been facilitated.Identify posting issues attributable to creating credit balances and relay this information to the Team Leader for audit purposes.Evaluate any refund/overpayment requests received. Responding appropriately by preparing to refund or written dispute.Transfer money when necessary via Issue Assistance.Understand and refer to managed care profiles, AWP grids, and other tools necessary to determine legitimate credits. Inform Team Leader of payer issues as identified.Complete a daily task log and submit to the Team Leader at the end of each month.Communicate with external departments, i.e., Registration, Front Office, etc, to obtain information required in resolving credit balances or refund requests.Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.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.One year of experience in directly related roleEssential Competencies:Attendance is an essential job function.Medical billing experience requiredDetailed knowledge of billing, HCPCS, CPT and ICD codesPrevious credit and refunds experience preferredAbility to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment and customer service orientation.Effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.Exceptional Multi-tasking, organizational skills and superb attention to detail.Strong analytical skillsSkill in negotiating issues and resolving problems.Excellent customer service skills.Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient billing and other medical information systems.Ability to operate various types of office equipment.Must possess high degree of professionalism and adaptability.