Lead AR Medical Insurance Specialist

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Oversee the revenue cycle workload and reallocate tasks as needed to ensure deadlines are met.

• Execute revenue cycle job functions as required to adhere to timelines.

• Guide team members' revenue cycle responsibilities, audit their work for precision and thoroughness, reassign tasks, and set priorities.

• Analyze reports to confirm that collection and billing submission tasks are finalized and deadlines are adhered to.

• Offer procedural guidance and support to team members.

• Investigate, resolve, or provide guidance on escalated issues.

• Educate team members on policies and procedures.

• Ensure that patients possess the necessary referral and authorization documents prior to examination dates.

• Follow up with physicians regarding any missing or incomplete documentation.

• Conduct spot-checks of patient charts for completeness.

• Communicate with clinical staff for clarifications on procedures, diagnoses, and missing information.

• Review claim denial reports and collaborate with colleagues on status and resolution.

• Examine payment postings and confirm that account balances are updated.

• Perform thorough account reconciliations.

• Code, process, and submit insurance claims to third-party payers.

• Identify and report trends among payers, patterns of denial, and delays; suggest write-offs as necessary.

• Uphold confidentiality and comply with state, federal, and HIPAA regulations and guidelines.

• Manage patient and payer credit balances, ensuring timely refunds.

• Identify gaps in revenue cycle processes and procedures, developing efficiency tools accordingly.

• Maintain and revise revenue cycle Standard Operating Procedures.

• Create training materials and tools as required.

• Support and adhere to the US Oncology Compliance Program, Code of Ethics, Business Standards, and Shared Values.

• Carry out other assigned responsibilities.

⛳️ Requirements

• High School diploma or equivalent is mandatory.

• An Associate's degree is preferred.

• A minimum of two (2) years of experience in insurance resolution, addressing issues with patients and payers.

• Four (4) years of combined experience in automated medical billing and payment is required.

• Proficiency in computer systems and Microsoft Office (Word and Excel) is essential.

• Knowledge of oncology medical coding is necessary.

• Familiarity with medical billing, payment, financial aid, insurance, and payer processes and procedures is required.

• Understanding of state, federal, and third-party claims processing is essential.

• Acquaintance with state and federal collections guidelines is required.

• Must successfully complete mandatory e-learning courses within 90 days of starting the position.

• Must be available online during standard business hours.

• Capability to sit or stand and communicate effectively; extensive sitting is required.

• Ability to occasionally lift and carry items weighing up to 40 lbs.

• Corrected vision and hearing to a normal range is necessary.

🏝️ Benefits

• Health, dental, and vision insurance plans.

• Wellness program.

• Health savings account.

• Flexible spending accounts.

• 401(k) retirement plan.

• Life insurance.

• Short-term disability insurance.

• Long-term disability insurance.

• Employee Assistance Program.

• Paid Time Off (PTO).

• Holiday pay.

• Employee-paid critical illness and accident insurance.

• Minimal travel may be required.