Insurance Specialist I

The US Oncology Network•Richardson, TX

8d•Onsite

About The Position

The US Oncology Network is looking for an Eligibility Specialist to join their team at Texas Oncology. This full-time position will support the Surgery Department at their location in Richardson, Texas. The company provides continuous feedback and educational opportunities, and this position can be hired at a level 1, 2, or Sr based on relevant work experience. Texas Oncology is the largest community oncology provider in the country, delivering high-quality, evidence-based care to patients close to home. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America, supported by McKesson Corporation.

Requirements

High school diploma or equivalent required.
Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Nice To Haves

Zero (0) to two (2) years of experience in front desk, registration, healthcare benefits, or equivalent experience.

Responsibilities

Under direct supervision, responsible for the successful resubmission of invoices to the responsible party.
Analyzes and resolves eligibility variances via web research and/or direct contact with patients.
Coordinates activities for the acquisition of referrals and retro-authorizations, where applicable.
Follows standard procedures and pre-established guidelines to complete tasks.
Supports and adheres to the Compliance Program, including the Code of Ethics and Business Standards, and Shared Values.
Researches and obtains accurate and current insurance coverage information; makes corresponding corrections in the practice management system (PMS).
May evaluate benefits and eligibility to assess patient financial responsibility.
May coordinate referrals from primary care providers to ensure appropriate authorizations are secured and entered into the PMS.
Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
Communicates system issues and/or payor trends to lead or supervisor.
May answer questions and resolve complaints.
Documents conversations with payors in the PMS.
Contacts and follows up with clinic staff regarding missing or incomplete documentation.
Works TES edits.
Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues.
Adheres to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records and collections.