Oncology Medical Billing & Coding Specialist

OneOncology, LLC; Nashville (TN); On-site; USD 45,000 - 70,000; Full time

Job summary

OneOncology, LLC is seeking a Medical Coding and Billing Specialist to manage proton therapy and radiology billing within the practice management system. You will verify insurance coverage, ensure charges are entered accurately, and submit timely claims to payers.

Responsibilities include monitoring claims, addressing denials, collaborating with pre-authorization teams, and maintaining detailed records. Strong Excel and Medicare/Medicaid knowledge are required.

Qualifications

• Bachelor's 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.

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 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.

Skills

CPT coding

HCPCS coding

ICD-9 coding

Insurance billing

Excel

MS Word

MS Outlook

Education

Bachelor's degree preferred

Tools

ACE rules

Unity

Practice management system

Job description

OneOncology, LLC is seeking a Medical Coding and Billing Specialist to manage proton therapy and radiology billing within the practice management system. You will verify insurance coverage, ensure charges are entered accurately, and submit timely claims to payers.

Responsibilities include monitoring claims, addressing denials, collaborating with pre-authorization teams, and maintaining detailed records. Strong Excel and Medicare/Medicaid knowledge are required.