Insurance Specialist Lead

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Overview

This position will work Monday-Friday 8am-5pm. Additionally, it is desired that the candidate reside in Texas.
As a part of

Overview
The US Oncology Network is looking for a n Insurance Specialist Lead to join our team at Texas Oncology ! This full time hybrid remote position will support our Regional Business Office at 8501 N. Mopac Suite 310 Austin, Texas 78759. This position will work Monday-Friday 8am-5pm. Additionally, it is desired that the candidate reside in Texas.
As a part of The US Oncology Network , Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same todayat Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve More breakthroughs. More victories. in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.
The US Oncology Network is one of the nations largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.
What does the Insurance Specialist Lead do?
With little or no supervision, monitors the revenue cycle work load and reassigns work as necessary to meet deadlines. Performs all revenue cycle job responsibilities as needed to meet deadlines. Utilizes broad range of knowledge including operating procedures, policies, regulations, and systems to accomplish responsibilities. A certain degree of creativity and latitude is required. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncologys Shared Values.
Responsibilities
The essential duties and responsibilities:

• Directs the revenue cycle work load of co-workers including auditing work for accuracy and completeness, re-assigning work, and establishing priorities
• Reviews reports to verify that collection and billing submission tasks are completed and deadlines are met
• Provides procedure guidance and direction to co-workers
• May research, resolve, or provide direction on co-workers escalated issues
• Trains co-workers on policies and procedures
• Verifies existing patients have necessary referral and/or authorization documentation prior to examination date
• Contacts and follows up with patients physician for any missing or incomplete documentation
• Spot checks patient charts for completeness
• Contacts clinical staff for clarification on procedures or diagnosis and on missing information
• Reviews reports for claim denials and works with co-workers on status and problem resolution
• Reviews payment postings for accuracy and to ensure account balances are current
• Performs detailed account reconciliation to resolve issues
• Codes, processes, and submits insurance claims to third party payor
• Identifies and reports any payer trends, denial patterns, and delays to management and recommends write-offs
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations
• Proactively identifies revenue cycle process and procedure gaps and develops tools to improve efficiencies
• Maintains and updates the Practices revenue cycle Standard Operating Procedures (SOPs)
• Trains coworkers on revenue cycle policies and procedures
• May develop training materials and tools
• Performs other duties as requested or assigned
  

Qualifications
The ideal candidate for the position will have the following background and experience:

• High School diploma or equivalent required. Associates degree in Finance, Business or four years revenue cycle experience preferred
• Minimum two (2) years insurance resolution experience resolving issues with patients and payors as well as four (4) years combined automated medical billing and payment experience required
• Proficiency with computer systems and Microsoft Office (Word and Excel) required
• Demonstrate knowledge of oncology medical coding required
• Demonstrate knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures
• Demonstrate knowledge of state, federal, and third party claims processing required
• Demonstrate knowledge of state and federal collections guidelines required
• Must successfully complete required e-learning courses within 90 days of occupying position
  

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The position requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. The position requires standing and walking for extensive periods of time. The employee occasionally lifts and carries items weighing up to 40 lbs. The position requires corrected vision and hearing to normal range.
Work Environment
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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