Medical Insurance Specialist

Overview: Under general supervision, is responsible for follow-up of outstanding AR, based upon assigned inventory. Performs follow-up with payers via payer portals and calls if on-line access is not available. Follow-up duties include identification of denials and submittal of appeals and supporting documentation based upon payer requirements. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology’s Shared Values.
Responsibilities:

• AR Rep works assigned inventory within the IDX/Athena system via on-line worklists.
• Reviews claims for no-activity, outstanding rejections or partially paid or underpaid claims for payer follow-up.
• Assigns the correct follow-up outcome within IDX/Athena to reflect action taken to requeue the claim for subsequent follow-up based upon the payer.
• Work all clearinghouse claim edits/rejections on a daily basis and processed according to CBO policies and procedures. All unresolved edits are escalated to the CBO Supervisor within the IDX/Athena system.
• Recommends accounts write-off using ImageNow system, along with supporting documentation justifying the adjustment.
• Verifies rejections for missing auth’s, referrals, NDC numbers, diagnoses codes are not missing the from submitted claim requiring corrected claim submitted in our G2 clinical system, but not reflected on the initial claim submitted.
• Contacts and follows up with patient’s physician for any missing or incomplete documentation that resulted in a denial. The AR Rep assigns the appropriate claim status outcome in IDX/Athena to reflect the reason claim is in a pended status.
• Works with co-workers to resolve payment and billing errors.
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records
• Performs other duties as requested or assigned.

Qualifications:

• High School diploma or equivalent required
• Minimum four (4) years’ experience in physician-based insurance follow-up
• Minimum of 1-year experience with IDX/Athena desired, but not required.
• CPC certification is desirable, but not required.
• Demonstrate knowledge of state, federal, and third- party claims processing required
• Must successfully complete required e-learning courses within 90 days of occupying position