Revenue Cycle Coverage and Claims Associate I

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At Exact Sciences, we're helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you're working to help others.

Position Overview

The Revenue Cycle Coverage and Claims Associate I will be responsible for the accurate and timely work of filing insurance claims for Exact Sciences. This role will demonstrate medical insurance knowledge by determining initial and/or ongoing eligibility, coverage, and related insurance reimbursement order details, including commercial, government, and all various plan coverage. This role will identify order and reimbursement deficiencies, route orders for appropriate actioning, and document actions taken within the systems for claims lifecycle tracking. This role will also support the broader activities of ensuring appropriate coverage by utilizing Epic, external portals, and other software, and communicate insurance information to ancillary departments and other teams within the reimbursement operations departments.


Essential Duties

Include, but are not limited to, the following:

• Maintain confidentiality and adhere to all HIPAA guidelines/regulations.
• Determine initial or ongoing patient insurance eligibility verification for all claims, including commercial and government insurance to the plan coverage and product level.
• Investigate and correct accounts within Epic and other systems/tools, including updates to patient demographics, financial information, and guarantor information.
• Interact with various insurances/third party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
• Research missing or erroneous information on accounts using various portals and other resources, including outreach and identification of unknown payors.
• Stay current with relevant medical billing regulations, rules, and guidelines.
• Provide ad-hoc support within the department for special projects and outages/high volume events.
• Complete position responsibilities within the appropriate time frame while adhering to quality standards.
• Ability to communicate effectively with all levels of staff through both verbal and written communications.
• Ability to work in a team environment and adapt to changing workload and circumstances effectively; able to respond to new information quickly.
• Ability to act in a professional manner in all interactions with members of the Exact Sciences clinical laboratory team, clients, and associates.
• Ability to work with others in a spirit of teamwork and cooperation.
• Excellent problem-solving abilities and organizational skills.
• Disciplined, self-motivated and 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.
• Possess a positive attitude.
• Ensure compliance with all Company procedures and guidelines; including, but not limited to, Code of Business Conduct and Ethics.
• 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.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work designated schedule.
• Ability to work overtime, as needed.
• Ability to work 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 General Education Degree (GED).
• 3+ months of experience in any healthcare field.
• Strong knowledge of order management, insurance claims procedures, electronic health record (EHR) operating systems.
• Basic knowledge of medical terminology and/or health insurance terms.
• Demonstrated strong attention to detail and focus on quality output.
• Proficient with electronic health records.
• Proficient in Microsoft Office programs, such as Word and Outlook.
• 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

• Associates Degree in field as outlined in the essential duties.
• 1+ years of experience in the medical or insurance billing field.
• Experience in revenue cycle platform applications.
• Medical billing certification.

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Salary Range:
$35,000.00 - $57,000.00


The annual base salary shown is for this position located in US - WI - Marshfield on a full-time basis. In addition, this position is bonus eligible.

Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. Learn more about our benefits.

Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging. If you require an accommodation, please contact us here.

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We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, and any other status protected by applicable local, state, or federal law.

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