Prior Authorization Associate I

RXinsider LTD.; Madison (WI); On-site; USD 21,000 - 40,000; Full time

Job summary

Exact Sciences in Madison, WI is seeking a Revenue Cycle Lead to support the Revenue Cycle Supervisors and Department, ensuring timely submission of claims, appeals, and cash posting while coordinating workflows. The role is cross-functional and involves hands-on leadership with staff.

The position requires strong billing knowledge, experience with billing software, and the ability to train and guide team members. Expect a collaborative, results-driven environment.

Qualifications

• High School diploma or GED.
• 2+ years of experience directly or indirectly leading others.
• 2+ years of experience in medical or insurance billing.
• Previous experience working with billing software.
• Demonstrated knowledge of medical billing principles and practices.
• Solid understanding of payer categories included Medicare, Medicaid, Medicare Advantage and Insurance Payers.
• Professional working knowledge of ICD-9 and ICD-10.
• Professional working knowledge of CPT.
• Professional working knowledge of EOB; able to read and interpret EOB for all payers.
• Proficient in Microsoft applications (Word, Excel, Power Point).
• Authorization to work in the United States without sponsorship.

Responsibilities

• Oversight of daily activities related to Revenue Cycle Team.
• Train and evaluate RC department staff.
• Develop and maintain procedures for efficient and accurate processing of claims, processing appeals, posting cash, and other functions as necessary.
• Process billing transactions in a timely and productive manner while meeting production goals and month end processing requirements.
• Perform ad-hoc audits and monitor work queues to ensure tasks are being performed in a timely manner.
• Handle escalations in an appropriate manner and keep leadership appraised.
• Ensure compliance with HIPAA and company guidelines.
• Act as subject matter expert and educate team on system workflows and guidelines.
• Suggest billing process/workflow updates/changes as necessary.
• Attend staff meetings and uphold company mission and values.

Skills

Leadership

Medical billing

Billing software

Microsoft Office

Education

High School diploma or GED

Associate Degree / Vocational-Technical

Tools

Billing software

Excel

Job description

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries.

The Revenue Cycle Lead is responsible for supporting the Revenue Cycle Supervisors and Revenue Cycle Department. The primary responsibility of the Revenue Cycle Lead is to support the timely and accurate submission of claims, appeals, and cash posting, monitor performance, provide training and coordinate workflows. This position is designed to be highly cross-functional and is a “working” Lead position with expectations of working alongside staff as well as providing direction.

Shift :

1st, 8am-5pm Monday - Friday

Essential Duties

Include, but are not limited to, the following :

• Responsible for oversight of daily activities as they relate to the Revenue Cycle Team.
• Assist in training and evaluating RC department staff.
• Develop and maintain procedures for efficient and accurate processing of claims, processing appeals, posting cash, and other functions as necessary.
• Process billing transactions in a timely and productive manner while meeting production goals and month end processing requirements.
• Perform ad-hoc audits and monitor work queues to ensure tasks are being performed in a timely manner.
• Handle escalations in an appropriate manner and keep leadership appraised. Understands external rules and regulations as they relate to healthcare billing and collections e.g. Medicare, Medicaid, state laws, Health Insurance Portability and Accountability Act (HIPAA), etc.
• Ensure compliance with all Company procedures and guidelines including but not limited to Code of Business Conduct and Ethics.
• Act as subject matter expert and assist in educating team on system(s), workflows and guidelines.
• Suggest billing process/workflow updates/changes as necessary.
• Conduct all assigned job duties in a timely and productive manner.
• Perform all job duties according to department policies and procedures.
• Provide extra resources when needed within the department (e.g. Special Projects, high volume functions along with constant Client and People Skill maintenance).
• Work with all areas of the department to ensure maximum productivity.
• Demonstrates good skills in all forms of communication and teamwork.
• Works well with others in a spirit of teamwork and cooperation.
• Excellent telephone etiquette required - Answers telephone calls in a timely and courteous manner.
• Demonstrated ability to read and comprehend written instructions.
• Disciplined, self-motivated & reliable; able to stay focused on a task and work independently; motivated to perform quality work; diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
• Possesses a positive attitude with excellent interpersonal skills and the ability to interact and build strong working relationships with customers as well as peers at all levels of the organization.
• Ability to work in a team environment and adapt to changing workload and circumstances effectively; able to respond to new information quickly.
• Conducts themselves in a professional manner in all interactions with members of the Exact Sciences team, clients and associates.
• Attend staff meetings or other company sponsored or mandated meetings as required.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Regular and reliable attendance.
• Ability to work designated schedule.
• Ability to work overtime as needed.
• Ability to work nights and/or weekends as needed.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• You will be required to successfully complete an assessment showing understanding of Exact Sciences Epic processes necessary to the job functions with a score of 80% or higher. Exact Sciences will make a reasonable accommodation available if necessary to assist an employee with a disability to satisfy this requirement.

Minimum Qualifications

• High School diploma or GED.
• 2+ years of experience directly or indirectly leading others.
• 2+ years of experience in medical or insurance billing.
• Previous experience working with billing software.
• Demonstrated knowledge of medical billing principles and practices.
• Solid understanding of payer categories included Medicare, Medicaid, Medicare Advantage and Insurance Payers.
• Professional working knowledge of International Classification of Diseases (ICD-9) an (ICD-10).
• Professional working knowledge of Coding Procedure Terminology (CPT).
• Professional working knowledge of Explanation of Benefits (EOB); able to read and interpret explanation of benefits (EOB) for all payers.
• Proficient in Microsoft applications (Word, Excel, Power Point).
• Demonstrated ability to perform the essential duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• 4+ years of medical billing and collections experience.
• Associate Degree, Vocational/Technical degree or certification.
• 3+ years of medical billing experience within the health care industry.
• Demonstrates initiative and willingness to continuously improve processes.

The base pay for this position is $14.85 – $29.65 per hour. In specific locations, the pay range may vary from the range posted.