Medical Coding and Billing Specialist

OneOncology

1d•Remote

About The Position

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision. Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve. Job Description: The Medical Coding and Billing Specialist is responsible for writing and maintaining coding and billing rules in the practice management system. The position is also responsible for reviewing and importing daily Urologic and Surgical charges and daily claim filing. Excellent verbal and written communication skills required. The coding and billing works under the direct supervision of their respective team manager.

Requirements

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.

Responsibilities

Review and verify patient insurance coverage and eligibility for Urologic and Surgical treatments.
Verify all applicable charges for Urologic and Surgical services are entered timely and accurately into the practice management system for reimbursement.
Generate and submit accurate and timely claims for Urologic and Surgical 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 Urologic and Surgical treatments.
Review and interpret insurance policies and regulations related to Urologic and Surgical treatments to ensure compliance with billing requirements.
Work collaboratively with the Urologic and Surgical center's medical and pre-authorization teams to ensure accurate and complete billing for their Urologic and Surgical treatments
Maintain accurate and up-to-date records of billing activities in patient files and computer systems
Ability to review and interpret Urologic and Surgical 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 Urologic and Surgical 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 Urologic and Surgical treatments.
Review and verify patient insurance coverage and eligibility for Urologic and Surgical 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.
Drafts appeal letters based on payer policy to support AR functions.
Reviews charges on “Hold” status daily for accuracy and corrective action.
Creates new Candid rules/edits as needed to reduce claim denials and/or manual review.
Maintains Candid rules to ensure data is current.
Answers Urologic and Surgical coding inquiries from the AR team.
Keeps informed regarding current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the fields of Urology and Surgery 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.