AR Medical Insurance Specialist Lead - Remote

The US Oncology Network•Norfolk, NY

7d•Remote

About The Position

The Insurance Specialist Lead directs and monitors revenue cycle work, including assigning and prioritizing tasks, checking work for accuracy and completeness, and helping the team meet deadlines. The role performs revenue cycle duties as needed and applies knowledge of operating procedures, policies, regulations, and systems, exercising a degree of creativity and latitude. It also supports and adheres to the US Oncology Compliance Program, Code of Ethics and Business Standards, and Shared Values. The position supports insurance verification, billing and claims processing, denial resolution, payment posting, account reconciliation, refunds, and patient and payer account maintenance. The lead guides and trains coworkers, addresses escalated issues, monitors reports and payer trends, and improves revenue cycle processes and procedures. Work is remote and involves online interaction with coworkers, management, and/or clients; minimal travel may be required.

Requirements

High school diploma or equivalent.
At least two years of insurance resolution experience resolving issues with patients and payors.
Four years of combined automated medical billing and payment experience.
Proficiency with computer systems and Microsoft Office, including Word and Excel.
Knowledge of oncology medical coding.
Knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures.
Knowledge of state, federal, and third-party claims processing.
Knowledge of state and federal collections guidelines.
Successfully complete required e-learning courses within 90 days of occupying the position.
Ability to be present online during regularly scheduled business hours.
Ability to meet the physical demands of the role, including extensive sitting, occasional lifting and carrying of items up to 40 pounds, and corrected vision and hearing to the normal range.

Nice To Haves

Associate degree.

Responsibilities

Direct the revenue cycle workload of coworkers, audit work for accuracy and completeness, reassign work, and establish priorities.
Review reports to verify collection and billing submission tasks are completed and deadlines are met.
Provide procedure guidance and direction to coworkers and research, resolve, or guide escalated issues.
Train coworkers on revenue cycle policies and procedures and, when needed, develop training materials and tools.
Verify existing patients have necessary referral and/or authorization documentation before examination dates.
Contact and follow up with patients’ physicians regarding missing or incomplete documentation.
Spot-check patient charts for completeness and contact clinical staff to clarify procedures, diagnoses, or missing information.
Review claim-denial reports and work with coworkers on status and resolution.
Review payment postings for accuracy and ensure account balances are current.
Perform detailed account reconciliation to resolve issues.
Code, process, and submit insurance claims to third-party payors.
Identify and report payer trends, denial patterns, and delays to management and recommend write-offs.
Follow confidentiality, state, federal, and HIPAA requirements regarding patient records.
Maintain patient and payor credit balances and ensure timely refunds within government guidelines and regulations.
Identify revenue cycle process and procedure gaps and develop tools to improve efficiency.
Maintain and update the Practice’s revenue cycle Standard Operating Procedures.
Perform other duties as requested or assigned.