Insurance Denial Specialist

The US Oncology Network is looking for an Insurance Specialist to join our team at Texas Oncology! This full-time hybrid remote position will support our Central Business Office at 3001 E President George Bush Hwy Richardson, TX 75082 This position will work 40 hours per week Monday-Friday and also requires the candidate to live in the state of Texas.

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.

What does the Insurance Specialist do?

Under general supervision, is responsible for payer Accounts Receivables being paid timely and remaining current. Performs collection activities such as monitoring denials, contacting payers for account payment, resolving billing problems, and answering routine and non-routine account inquiries. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

The essential duties and responsibilities:

• Monitors delinquent accounts and performs actions to resolve claim denials.
• Reviews reports, researches and resolves claim denial issues.
• Works with co-workers to resolve insurance payment and billing errors.
• Monitors and updates delinquent accounts status.
• Recommends accounts for denial adjustments or write-offs.
• File appeals, check claim status, updates insurance information to refile claims, monitors claims with no payer response, research payer policies for reconsiderations and appeals, and works with the team to identify trends to prevent future denials.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records.
• Performs other duties as requested or assigned.

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

Level 2

• High School diploma or equivalent required.
• Minimum four (4) years combined medical billing and payment experience required. This includes: researching payer policies, NCCI Edits and Manual, filing reconsiderations and appeals, and experience with various payer portals.
• Demonstrate knowledge of state, federal, and third party claims processing required.
• Demonstrate knowledge of medical coding, preferably oncology coding.
• Demonstrate knowledge of state & federal collections guidelines.
• Certified Professional Coder (CPC) or Certified Professional Biller (CPB) desired.
• Proficiency with computer systems and Microsoft Office (Word and Excel) desired.
• Must successfully complete required e-learning courses within 90 days of occupying position.

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.