Reimbursement Spec II - SIGN ON BONUS ELIGIBLE

Augusta Health Careers • Fishersville, VA

7d • Onsite

About The Position

This position plays a critical role in supporting Augusta Health’s mission and advancing departmental goals through measurable performance indicators and service excellence. This position contributes to a collaborative, patient-centered environment and helps drive outcomes aligned with organizational priorities. The Reimbursement Specialist II – Cancer Center performs foundational oncology revenue cycle duties, including insurance verification, prior authorizations, patient financial communication, administrative coordination, and support for denial prevention and resolution. In addition, this role applies coding guidelines, reviews charges and modifiers, verifies billing accuracy, and helps prevent billing errors. The incumbent works with increasing independence while collaborating with clinical, billing, and reimbursement teams to maintain coding integrity and ensure timely and compliant claim submission within the Cancer Center.

Requirements

• High School Diploma or equivalent
• One of the following active credentials within one (1) year of hire: Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC)
• Five years' experience in healthcare customer service
• Five years' experience in oncology reimbursement/coding
• Five years' experience in authorization, insurance verification, claim adjudication, medical office billing, or outpatient billing
• Eligibility to work in the United States and meet Virginia state employment requirements

Nice To Haves

• Associate's Degree
• CCS
• RHIT
• RHIA
• Oncology-related coding experience, including hands-on or on-the-job exposure
• Prior experience in a hospital, healthcare system, or related service-oriented environment
• Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus

Responsibilities

• Obtains and verifies insurance benefits, pre-determinations, and prior authorizations for chemotherapy, infusions, radiation oncology, oncology procedures, and related Cancer Center services.
• Ensures required documentation and medical necessity criteria are secured prior to treatment.
• Determines medical necessity based on current payer polices and stays updated on clinical bulletins.
• Evaluates eligibility for free-drug programs based on diagnosis, insurance, and financial information; obtains consents and documentation.
• Reviews patient accounts prior to service to determine anticipated reimbursement and estimated patient responsibility.
• Communicates financial information clearly with patients and the clinical teams; identifies appropriate oncology-specific financial assistance programs.
• Performs general administrative and clerical support functions (correspondence, document distribution, record maintenance).
• Provides documentation to support review with denials management.
• Assists in drafting appeals packets by gathering clinical notes, coding summaries, and supporting documents for review by senior denial specialists before submission.
• Provides support in preparing resolution materials for denied or rejected claims, such as assembling documentation for rebilling, appeals, or payer follow-up, and routing items to the appropriate team members.
• Obtains retro authorizations for denied services, updates patient accounts with the retro authorization and communicates with the billing department to have claims resubmitted.
• Prepares financial, denial, productivity, and reimbursement reports as assigned and submits required variation or productivity reports within established timeframes.
• Serves as a liaison between physicians, clinical staff, patient accounting, scheduling, ancillary departments, payer representatives, and leadership to promote operational efficiency, denial prevention, coding integrity, and optimal reimbursement within the Cancer Center.
• Assigns and reports accurate diagnosis and procedure codes in accordance with AHA Coding Clinic, ICD-10-CM, CPT, NCCI, OPPS, CMS, and payer-specific guidelines.
• Ensures appropriate DRG/APC assignment and modifier usage to support compliant billing and optimal reimbursement (under supervision of CPC).
• Enters and reviews charges within billing systems; verifies supporting documentation and ensures accuracy of demographic and insurance data (under supervision of CPC).
• Manages NCCI and OPPS edits, appending modifiers as appropriate and coordinating charge corrections with ancillary departments and the Business Office.
• Maintains established coding accuracy benchmarks for principal/secondary diagnoses and procedural coding.
• Monitors assigned accounts to ensure timely claim submission and adherence to bill-drop and A/R standards.
• Reviews payer reimbursement policies, contractual guidelines, and updates; communicates relevant changes to impacted departments and colleagues.
• Supports the Denials Management team by gathering documentation and assisting in the review of insurance denial reason codes to help ensure accuracy and timely processing.
• Assists with compiling and organizing denial data to help identify trends by payer and reason code, and provides information needed for financial impact assessments and root–cause discussions.
• Helps maintain denial and appeal tracking logs, updates follow up dates, and supports monitoring of KPIs to ensure activities remain within payer filing limits.
• Supports root cause analysis efforts by collecting examples, organizing data, and preparing summaries for review by clinical, coding, and patient accounting teams.
• Identifies and flags documentation or workflow gaps for review by senior staff and assists in preparing educational materials or feedback summaries.
• Assists in monitoring reimbursement accuracy by compiling payment information, identifying variances, and routing discrepancies to analysts for further review.
• Provides administrative support for payer settlement activities, including gathering required documentation and coordinating communication with external partners as directed.
• Assists in preparing routine financial, denial, productivity, and reimbursement reports by collecting data, formatting materials, and ensuring information is ready for analyst or leadership review.

Benefits

• Comprehensive insurance package including medical, dental, and vision coverage
• Retirement savings plans and financial wellness support programs
• Generous paid time off and flexible scheduling to promote work-life balance
• Career development programs including clinical ladders, shared governance, and advancement opportunities
• Personalized onboarding with dedicated preceptors and ongoing educational support
• Tuition reimbursement
• Access to onsite childcare
• Free onsite parking
• 24/7-armed security for your safety
• Health Fitness Reimbursement Program
• Onsite credit union and pharmacy
• Competitive pay with shift/weekend differentials
• Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues (i.e., movie tickets)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED