Essential Functions

Follow up on open claims in accordance with established guidelines. Review claims for  completeness and compliance with billing guidelines.

Works to resolution disputes and appeals of third-party denials. Identifies, reviews, and contests denials and inappropriate payments. Documents actions taken within the system.

Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or  Federal governmental, CMS, or CPT billing and reimbursement guidelines, to include NCCN and FDA guidelines.  Reviews bulletins, updates, etc., maintains guidelines as reference/resource material to assist in follow-up.

Responsible for auditing all chemotherapy/Nurse run payments to ensure they are correct, and appeal  claims as necessary.

Acts as liaison to the Chemotherapy/Nurse Run Department to ensure any special projects and  requests are completed efficiently and correctly.

Accesses available third-party and governmental on-line services. Accesses appropriate web sites to obtain current carrier guidelines, verify eligibility and re-files claims.

Possesses a comprehensive understanding of how to enter insurance information into the billing system. Reviews and edits registration information according to Clinic policy. Remain current on new FSC's that are created and understand how they are used.

Supervisory Responsibility

none

Work Environment & Physical Demands
Must be able to remain in a stationary position. Constantly operates a computer and other office productivity machinery, such as a calculator, copier and computer printer.

The person in this position frequently communicates with customers. Must be able to exchange accurate information in these situations. 

Travel
No travel is expected for this position other than monthly meetings at CCR. 

 Required Education and Experience 

High School graduate or equivalent. 6 years in a medical business office or related field.

Experience with the claim’s adjudication process for multiple governmental agencies and   private insurance carriers. Basic medical terminology. Current CPT and ICD-10 coding experience.

Preferred Education and Experience
 AA degree or minimum of 2 years’ experience with retail pharmaceutical disruption as well as an understanding of units of measure with drug distribution. A knowledge of drug uses based on clinical DX.

Additional Eligibility Qualifications

An aptitude to retain detailed information. Ability to be multi-tasked oriented, to prioritize and to produce an acceptable volume of work. Excellent organizational and problem­ solving skills. Excellent communication skills, oral and written. Basic knowledge of Windows-based computer applications.  Accurate typing rate of 40 wpm. Ability to operate the following equipment: computer, copier, fax, and 10-key calculator.