Insurance Specialist II - Credit Balance Team

Overview

The US Oncology Network is looking for a Insurance Specialist to join our team at Texas Oncology . This full-time position will support our Revenue Cycle Department at our 3001 E. President George Bush Highway Suite 100 in Richardson, Texas. Typical work week is Monday through Friday, 7:00a - 3:30p.


As a part of The US Oncology Network , Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology , we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." ® in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.


The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.


Responsibilities

The essential duties and responsibilities:

• Maintains Federal and Commercial credits under 60 days, following Federal guidelines as well as TXO policy and procedure.
• Reviews reports, identifies overpayments, researches and resolves issues, may perform a detailed reconciliation of batches, and resubmits refunds.
• Reviews payment postings for accuracy and to ensure account balances are current.
• Works with co-workers to resolve payment and billing errors.
• Applies patient money towards account write offs or balances with patient responsibilities.
• Contacts and follows up with Insurance companies for COB details, recoup information or update of addresses.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Contacts patients to explain why a refund has been issued on our behalf, as well as possible address updates.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records.
• Performs other duties as requested or assigned.

Qualifications

The ideal candidate for the position will have the following background and experience:

Level 1

• High School diploma or equivalent required.
• Minimum two (2) years combined medical billing and payment experience required.
• Demonstrate knowledge of state, federal, and third party claims processing required.
• Demonstrate knowledge of state & federal collections guidelines.
• Must successfully complete required e-learning courses within 90 days of occupying position.

Level 2 (in addition to level 1 requirements)

• Minimum four (4) years combined medical billing and payment experience required
• Demonstrate knowledge of medical coding, preferably oncology coding

Level Sr (in addition to level 1 and 2 requirements)

• Associates degree in Finance, Business or four years revenue cycle experience preferred
• Minimum two (2) years insurance resolution experience resolving issues with patients and payers as well as four (4) years combined medical billing and payment experience required
• Proficiency with computer systems and Microsoft Office (Word and Excel) required
• Demonstrate knowledge of oncology medical coding
• Demonstrate knowledge of state, federal, and third party claims processing required

Competencies

• Uses Technical and Functional Experience
• Possesses up to date knowledge of the profession and industry
• Accesses and uses resources when appropriate
• Demonstrates Adaptability
• Handles day to day work challenges confidently
• Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change
• Shows resilience in the face of constraints, frustrations, or adversity
• Demonstrates flexibility
• Customer Service
• Demonstrates positive interpersonal relations in dealing with fellow employees, supervisors, physicians, patients as well as outside contacts so that productivity and positive employee/patient relations are maximized.
• Uses Sound Judgment
• Makes timely, cost effective, and sound decisions
• Makes decisions under conditions of uncertainty
• Shows Work Commitment
• Sets high standards of performance
• Pursues aggressive goals and works efficiently to achieve them
• Commits to Quality
• Emphasizes the need to deliver quality products and/or services
• Defines standards for quality and evaluates products, processes, and services against those standards
• Manages quality
• Improves efficiencies
  Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to manipulate a computer keyboard and mouse. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.
  
  Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent contact with staff. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to blood, toxic substances, ionizing radiation and other conditions common to a clinic environment.