Job Description

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.

Education, Licensure/ Certification and Experience requirements:

• High School Diploma or equivalent required
• Associate degree preferred
• One of the following active credentials within one (1) year of hire: Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Outpatient Coder (COC), or Certified Inpatient Coder (CIC) required
• CCS, RHIT, RHIA preferred
• Five years’ experience in healthcare customer service required
• Five years’ experience in oncology reimbursement/coding required
• Five years’ experience in authorization, insurance verification, claim adjudication, medical office billing, or outpatient billing required
• Oncology-related coding experience, including hands-on or on-the-job exposure preferred.

Competencies, Knowledge, Skills and Abilities:

• Knowledge of medical terminology, anatomy and physiology, disease processes, and oncology-specific healthcare operations, including reimbursement, billing, coding, compliance, and revenue cycle procedures.
• Working knowledge of medical office operations, clinic policies, payer guidelines, and healthcare information systems, including EMRs, coding/abstracting software, grouper systems, and Medicare edits.
• Proficiency in computer applications including Microsoft Office (Excel, Word), clinical IT applications, and standard office equipment; demonstrated keyboarding skills.
• Ability to accurately interpret clinical documentation, abstract data, assign appropriate codes, review charges, and analyze reimbursement and denial trends.
• Strong organizational, prioritization, and time management skills, with the ability to manage multiple tasks, meet deadlines, and maintain accuracy in a dynamic environment.
• Effective written, verbal, and interpersonal communication skills, including the ability to interact professionally with patients, families, physicians, leadership, payer representatives, and colleagues.
• Demonstrated customer service and patient-centered skills, with the ability to foster cooperative working relationships and create a positive experience for patients and internal stakeholders.
• Ability to work independently with minimal supervision while also functioning collaboratively as part of a team.
• Sound judgment and decision-making skills, with the ability to identify problems, recommend solutions, and support process improvements consistent with organizational standards and internal controls.
• Maintains strict confidentiality and compliance with privacy regulations, ensuring appropriate handling and disclosure of protected health information.
• Demonstrates professionalism, respect for individual dignity and cultural diversity, and commitment to high-quality patient care.
  

Some benefits of working at Augusta Health include:

• Generous paid time off to promote work life balance
• Competitive Pay
• Retirement Plan
• Medical, Dental, and Vision Benefits
• Free onsite parking
• Tuition reimbursement
• Onsite childcare

Company Information:

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient services which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

Equal Opportunity:

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.