AR Medical Insurance Specialist Lead - Remote

The US Oncology Network is looking for an upbeat and ambitious Remote Insurance Specialist Lead. US Oncology is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer!

Pay Range: $25-30/hr

Pay is based on several factors including but not limited to education, work experience, etc. As of the date of this posting, in addition to your salary, we offer the following benefits for this position, subject to eligibility requirements: Health, dental, and vision plans; wellness program; health savings account; flexible spending accounts; 401(k) retirement plan; life insurance, short-term disability insurance; long-term disability insurance, Employee Assistance Program; PTO, holiday pay, and employee paid critical illness and accident insurance.

SCOPE
• With little or no supervision, monitors the revenue cycle work load and reassigns work as necessary to meet deadlines
• Performs all revenue cycle job responsibilities as needed to meet deadlines
• Utilizes broad range of knowledge including operating procedures, policies, regulations, and systems to accomplish responsibilities
• A certain degree of creativity and latitude is required
• Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology’s Shared Values

ESSENTIAL DUTIES AND RESPONSIBILITIES

Directs the revenue cycle work load of co-workers including auditing work for accuracy and completeness, re-assigning work, and establishing priorities

• Reviews reports to verify that collection and billing submission tasks are completed and deadlines are met
• Provides procedure guidance and direction to co-workers
• May research, resolve, or provide direction on co-workers’ escalated issues
• Trains co-workers on policies and procedures
• Verifies existing patients have necessary referral and/or authorization documentation prior to examination date
• Contacts and follows up with patient’s physician for any missing or incomplete documentation
• Spot checks patient charts for completeness
• Contacts clinical staff for clarification on procedures or diagnosis and on missing information
• Reviews reports for claim denials and works with co-workers on status and problem resolution
• Reviews payment postings for accuracy and to ensure account balances are current
• Performs detailed account reconciliation to resolve issues
• Codes, processes, and submits insurance claims to third party payor
• Identifies and reports any payer trends, denial patterns, and delays to management and recommends write-offs
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations
• Proactively identifies revenue cycle process and procedure gaps and develops tools to improve efficiencies
• Maintains and updates the Practice’s revenue cycle Standard Operating Procedures (SOPs)
• Trains coworkers on revenue cycle policies and procedures
• May develop training materials and tools
• Performs other duties as requested or assigned

MINIMUM QUALIFICATIONS
• High School diploma or equivalent required, Associates degree preferred.
• Minimum two (2) years insurance resolution experience resolving issues with patients and payors as well as four (4) years combined automated medical billing and payment experience required
• Proficiency with computer systems and Microsoft Office (Word and Excel) required
• Demonstrate knowledge of oncology medical coding required
• Demonstrate knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures
• Demonstrate knowledge of state, federal, and third party claims processing required
• Demonstrate knowledge of state and federal collections guidelines required
• Must successfully complete required e-learning courses within 90 days of occupying position