Revenue Cycle Associate II

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

📋 Description

• Accurately and promptly file insurance claims for Abbott Cancer Diagnostics.

• Assess initial and ongoing insurance eligibility, coverage details, and reimbursement order specifics for patients.

• Identify deficiencies in orders and reimbursements, redirect orders for necessary actions, and assist in triaging.

• Record actions within systems to track the lifecycle of claims.

• Address escalated claims that cannot be resolved by Revenue Cycle Coverage and Claims Associate I.

• Engage in bulk claim projects.

• Utilize Epic, external portals, and various software to confirm appropriate coverage.

• Relay insurance information to ancillary departments and reimbursement operations teams.

• Verify patient insurance eligibility and correct account details in Epic, including demographics, financial data, and guarantor information.

• Communicate with insurers and third-party payors to obtain and document necessary authorizations.

• Investigate missing or incorrect account information, including unknown payors.

• Review and modify claims and appeals before submission to the clearinghouse.

• Analyze, investigate, and resolve claim issues in compliance with federal, state, and payor regulations.

• Monitor work queues for claims needing further research and resolution efforts.

• Provide CRM support and manage documents in OnBase for the TOQ department.

• Correct claims rejected by claim scrubbers, clearinghouses, or payors.

• Examine explanations of payment and resolve denials through appeals, write-offs, or statements.

• Validate new workflows and manage specific work queues until setup is confirmed.

• Investigate underpayments by payors and follow up on unpaid aging claims via phone.

• Supply supporting documentation to insurance payors.

• Execute accurate and timely write-offs for uncollectible accounts.

• Offer ad-hoc departmental support during special projects, system outages, or peak volume periods.

• Uphold quality, confidentiality, and HIPAA compliance.

• Remain informed on medical billing regulations, standards, and guidelines.

• Support company policies and procedures related to the Quality Management System.

⛳️ Requirements

• High School Diploma or General Education Degree (GED) is required.

• Minimum of 1 year in a revenue cycle role.

• At least 3 years of experience in medical billing, claims, and/or insurance processing.

• In-depth and current knowledge of claim submission requirements, reimbursement guidelines, and denial reason codes for government, managed care, and commercial insurances.

• Familiarity with medical terminology and/or health insurance terms.

• Knowledge of EHR operating systems and experience with electronic records.

• Proficient in computer systems and possess strong keyboarding skills.

• Proven ability to demonstrate strong attention to detail and focus on delivering quality output.

• Capability to perform the essential duties of the position with or without accommodation.

• Authorized to work in the United States without sponsorship.

• Availability to work Monday through Friday during regular business hours.

• Ability to work in front of a computer screen and/or type for approximately 90% of a typical workday.

• Capacity to operate a computer and phone simultaneously.

• Ability to use a telephone with a headset.

• Successfully complete an assessment demonstrating understanding of Exact Sciences Epic processes with a score of 80% or above.

• Related Associate's degree or medical billing certification is preferred.

• Over 5 years of experience in the medical or insurance billing field is preferred.

• Experience with Epic or other EHR applications is preferred.

🏝️ Benefits

• Equal Opportunity Employer protections for Minorities/Women/Individuals with Disabilities/Protected Veterans.

• Reasonable accommodations available for employees with disabilities, if necessary.

• No travel required.