Sr. RCM Specialist

OneOncology

20h

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 Senior Revenue Cycle Specialist will report to the Supervisor, Manager, Director or Senior Director of Revenue Cycle and will be part of the Revenue Cycle team. The Senior Revenue Cycle Specialist is responsible for a wide range of revenue cycle processes. Each Senior may supervise 1-3 Revenue Cycle Specialists and have additional and specialized expertise in medical coding and insurance billing as well as expertise in insurance reimbursement processes and regulations. Senior Revenue Cycle Specialist will have at least 5 years in the above areas and demonstrated ability to oversee and coordinate revenue cycle activities for specific payers accordingly. In addition these positions will be responsible for outlining work flows and procedures specific to RCM activities as needed. Senior Revenue Cycle Specialists will have increased exposure and provide support to senior leadership. It is a great opportunity to develop managerial, leadership and reporting skills in an active, collaborative, and growing environment with regular exposure to senior leadership.

Requirements

Attendance is an essential job function.
Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
Detailed knowledge of billing, HCPCS, CPT and ICD codes
Ability to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment and customer service orientation.
Exceptional Multi-tasking, organizational skills and superb attention to detail.
Strong analytical skills and ability to meet assigned deadlines
Strong knowledge of Windows-based applications (Word, Outlook, Excel, etc)
Ability to operate various types of office equipment.
Must possess high degree of professionalism and adaptability.
High School diploma or equivalent required
Previous experience in Charge Entry, Billing or Coding required in an Oncology healthcare setting
At least 5 years of expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid
Travel flexibility (if applicable)

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Confirm insurance benefits and eligibility for patients as required
Request authorizations from payers for radiation therapy and imaging services as required
Reviews and understands the reasons for authorization denials and completes the appropriate steps/actions to correct submission errors, and/or submit upfront appeals to the payer for authorization approvals
Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.
Communicate with patients and families about the status of pre-authorization and appeals for radiation therapy treatments, including providing education about insurance coverage and benefits
Review and enter Radiation Oncology and Imaging charges into practice management system
Audit charges and communicate outstanding charges and/or questions with clinical staff.
Ensures that claims for all services rendered are submitted to the payers within the timely filing guidelines of each individual payer with minimal errors
Communicate openly with Clinical staff and RCM teams to ensure timely and accurate billing is completed
Monitor and track claims through the billing process to ensure timely payment and identification of payer roadblocks
Work assigned Unity tasks daily to resolve any tasks identified by ACE edits, rejections, denials, collectors or other RCM teams
Identify and work tickets to resolution in various statuses within the Practice Management system daily
Ability to review, interpret and apply knowledge of billing guidelines and medical policies
Train with team members or other employees when assigned by management
Maintains a complete understanding of HCPCS/ICD/CPT oncology coding and specific carrier requirements/knowledge
Recognizes problems or trends and provides suggestions to help find resolutions
Delivers timely responses to emails and telephone messages as appropriate
Keeps informed of current industry trends, coding regulations, changes to insurance policies, and other developments impacting the field of radiation therapy and radiology and effectively communications and applies this knowledge
Follows policy and procedures outlined by management to ensure standardization of processes
Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.