The Medical Coding and Billing Specialistis responsible forwriting andmaintainingcoding and billing rules in the practice management system. The position is also responsible for reviewing and importing daily charges in Radiology Authorization Specialist and daily claim filing. Excellent verbal and written communication skillsrequired The coding and billingworksunder the direct supervision of their respective team manager.  

Responsibilities

• Review and verify patient insurance coverage and eligibility for proton therapy treatments. 

• Verify all applicable charges for proton therapy, radiation therapy, and radiology services are enteredtimelyand accurately into the practice management system for reimbursement. 

• Generate andsubmitaccurateandtimelyclaims for proton therapy, radiation therapy, and radiology services to insurance payers. 

• Monitor and track claims through the billing process to ensuretimelypayment and identification of payer roadblocks. 

• Assistwith investigation and resolution of any claim rejections, denials, or appeals related to proton therapy treatments. 

• Review and interpret insurance policies and regulations related to proton therapy treatments to ensure compliance with billing requirements. 

• Work collaboratively with the proton therapy center's medical and pre-authorization teams to ensureaccurateand complete billing for proton therapy and radiation therapy treatments 

• Maintainaccurateand up-to-date records of billing activities in patient files and computer systems 

• Ability to review and interpret radiation oncology medical records for accuracy as it relates to coding and billing.  Educate clinical team onappropriate documentationrequirements. 

• Assistteam members with responses to patient and insurance company inquiries about billing for proton therapy treatments ina timelyand professional manner 

• Stay current with industry trends, changes to insurance policies, and other developments that mayimpactthe billing process for proton therapy and radiation therapy treatments. 

• Review and verify patient insurance coverage and eligibility for proton therapy treatments as needed. 

• Reviews charges in “Approve Failed” status daily for accuracy and corrective action. 

• Contacts theappropriate departmentto follow up on pending issues for insurance and referrals. 

• Works Research ACE tasks in Unity daily. 

• Reviews charges on “Hold” status daily for accuracy and corrective action.  

• Creates new Ace rules/edits as needed to reduce claim denials and/or manual review. 

• Maintains Ace rules to ensure data is current. 

• Runs Ace edits daily and files paper and electronic claims to the appropriatepayors 

• Keeps informedregardingcurrent coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the field of medical oncology and effectivelyappliesthis knowledge. 

• Communicates effectively withpracticeleadershipregardingcoding issues to help ensure coding compliance and minimize denials. 

• Demonstrates outstanding work ethic and works cooperatively with all team members and management.  

• Additionalresponsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer. 

RequiredQualifications

EDUCATION & EXPERIENCE:

• Bachelorsdegree preferred/High School Diploma/GED required.

• Minimum two years’ experience inchargeentry/billingrequired  

• 1+ year(s) of Prior Authorization experience.

• Extensive knowledge of CPT, HCPCS, and ICD-9 coding in addition to insurance billing guidelinesrequired  

• Proficiencyin Microsoft EXCEL spreadsheets and strong computer background.   

• Medical insurance backgroundrequired

• Expertisein insurance policies and regulations related to medical billing, including Medicare and Medicaid

PHYSICAL REQUIREMENTS:

• Must be willing and able tolift upto 25 pounds.

• Must be willing and able to travel to satellite clinics when necessary.

EssentialCompetencies:

• Attendance is an essential job function.

• Ability to work effectively with all levels of management and other colleagues

• Ability todemonstrateinitiative and mature judgment.

• Ability todemonstratehighdegree of professionalism and adaptability.

• Ability todemonstrateproficiencyin the use of end-user computer applications (MSwork, Excel, Outlook), database and patient scheduling and other medical information systems.

• Ability todemonstratestrong customer service delivery skills.

• Ability toutilizewebsites,portaland 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 solvingskillsand the ability to analyze and respond to data.

• Skilled at effective verbal and written communications, including active listening skills andskillin presenting findings and recommendations.

• Skilled atMulti-tasking, organizational skills and superb attention to detail.

• Working knowledge of Hospice and other payer requirements.

• Knowledge of clinic office procedures, medicalpracticeand medical terminology.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.