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Medical Coding & Billing Specialist

OneOncology
USA
Full-time
Junior · 2+ years experience
Onsite
Discovered 2 days ago
excel

Full Job Posting

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 Research 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.
  • Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications:

  • EDUCATION & EXPERIENCE:
  • · Bachelors 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
  • PHYSICAL REQUIREMENTS:
  • · Must be willing and able to lift up to 25 pounds.
  • · Must be willing and able to travel to satellite clinics when necessary.
  • Essential Competencies:
  • · Attendance is an essential job function.
  • · Ability to work effectively with all levels of management and other colleagues
  • · Ability to demonstrate initiative and mature judgment.
  • · Ability to demonstrate high degree of professionalism and adaptability.
  • · Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
  • · Ability to demonstrate strong customer service delivery skills.
  • · Ability to utilize websites, portal and electronic options when available to increase efficiency
  • · Ability to follow oral and written instructions.
  • · Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
  • · Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
  • · Skilled at Multi-tasking, organizational skills and superb attention to detail.
  • · Working knowledge of Hospice and other payer requirements.
  • · Knowledge of clinic office procedures, medical practice and medical terminology.
  • The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.

Preferred Qualifications

  • · Bachelors degree preferred

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