Medical Billing & Coding Specialist

DaMar Staffing; Nashville (TN); On-site; USD 55,000 - 75,000; Full time

Job summary

OneOncology is seeking a Medical Coding and Billing Specialist to write and maintain coding rules, review daily charges in radiology and proton therapy workflows, and file claims. Excellent verbal and written communication skills are required, and the role works under the supervision of the team manager.

The position requires reviewing insurance coverage, timely charge entry, claim submission, and ongoing denials management while staying current with coding regulations and collaborating with the

Qualifications

• Bachelor’s degree preferred and two years’ charge entry/billing experience.
• Proficiency with CPT, HCPCS and ICD-9 coding and payer guidelines.
• Strong Excel skills and medical insurance background.

Responsibilities

• Review patient insurance coverage and eligibility for proton therapy and related services.
• Enter charges timely and accurately for proton, radiation, and radiology services.
• Generate and submit claims to insurance payers and monitor processing.
• Investigate denials, mispayments, or appeals and resolve promptly.
• Maintain billing records and ensure compliance with policies and procedures.
• Collaborate with clinical teams to ensure accurate documentation and coding.

Skills

CPT/HCPCS/ICD-9 coding

Excel

Medical billing background

Insurance policies/regulations

Education

Bachelor's degree preferred

Tools

Unity

ACE rules

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:

The Medical Coding and Billing Specialist is responsible for writing and maintaining coding and billing rules in the practice management system. The position is also responsible for reviewing and importing daily charges in Radiology Authorization Specialist and daily claim filing. Excellent verbal and written communication skills required. The coding and billing works under the direct supervision of their respective team manager.

Responsibilities:

• Review and verify patient insurance coverage and eligibility for proton therapy treatments.
  
• Verify all applicable charges for proton therapy, radiation therapy, and radiology services are entered timely and accurately into the practice management system for reimbursement.
  
• Generate and submit accurate and timely claims for proton therapy, radiation therapy, and radiology services to insurance payers.
  
• Monitor and track claims through the billing process to ensure timely payment and identification of payer roadblocks.
  
• Assist with investigation and resolution of any claim rejections, denials, or appeals related to proton therapy treatments.
  
• Review and interpret insurance policies and regulations related to proton therapy treatments to ensure compliance with billing requirements.
  
• Work collaboratively with the proton therapy center's medical and pre-authorization teams to ensure accurate and complete billing for proton therapy and radiation therapy treatments
  
• Maintain accurate and up-to-date records of billing activities in patient files and computer systems
  
• Ability to review and interpret radiation oncology medical records for accuracy as it relates to coding and billing. Educate clinical team on appropriate documentation requirements.
  
• Assist team members with responses to patient and insurance company inquiries about billing for proton therapy treatments in a timely and professional manner
  
• Stay current with industry trends, changes to insurance policies, and other developments that may impact the billing process for proton therapy and radiation therapy treatments.
  
• Review and verify patient insurance coverage and eligibility for proton therapy treatments as needed.
  
• Reviews charges in "Approve Failed" status daily for accuracy and corrective action.
  
• Contacts the appropriate department to follow up on pending issues for insurance and referrals.
  
• Works Research ACE tasks in Unity daily.
  
• Reviews charges on "Hold" status daily for accuracy and corrective action.
  
• Creates new Ace rules/edits as needed to reduce claim denials and/or manual review.
  
• Maintains Ace rules to ensure data is current.
  
• Runs Ace edits daily and files paper and electronic claims to the appropriate payors.
  
• Keeps informed regarding current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the field of medical oncology and effectively applies this knowledge.
  
• Communicates effectively with practice leadership regarding coding issues to help ensure coding compliance and minimize denials.
  
• Demonstrates outstanding work ethic and works cooperatively with all team members and management.
  
• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.
  

Required Qualifications:

EDUCATION & EXPERIENCE:

• Bachelors degree preferred
  
• Minimum two years' experience in charge entry/billing required.
  
• 1+ year(s) of Prior Authorization experience.
  
• Extensive knowledge of CPT, HCPCS, and ICD-9 coding in addition to insurance billing guidelines required.
  
• Proficiency in Microsoft EXCEL spreadsheets and strong computer background.
  
• Medical insurance background required.
  
• Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid
  

Essential Competencies:

• Attendance is an essential job function.
  
• Ability to work effectively with all levels of management and other colleagues
  
• Ability to demonstrate initiative and mature judgment.
  
• Ability to demonstrate high degree of professionalism and adaptability.
  
• Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
  
• Ability to demonstrate strong customer service delivery skills.
  
• Ability to utilize websites, portal and electronic options when available to increase efficiency
  
• Ability to follow oral and written instructions.
  
• Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
  
• Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
  
• Skilled at Multi-tasking, organizational skills and superb attention to detail.
  
• Working knowledge of Hospice and other payer requirements.
  
• Knowledge of clinic office procedures, medical practice and medical terminology.