Insurance Credit Balance Specialist

The US Oncology Network is looking for an Insurance Specialist to join our Credit Balance team at Texas Oncology! This full time hybrid remote position will support our Regional Business Office at 8501 N. Mopac Suite 310 - Austin, TX 78759. This is a full-time Monday through Friday 8am-5pm position. Additionally, this position desires a candidate that lives in the state of Texas.

This position can be either a level 1, 2 or Sr based on candidate experience.

Notes from the hiring manager: At Texas Oncology, we believe that exceptional care starts with an exceptional team. We offer competitive pay, comprehensive benefits, and a supportive work environment where employees are truly valued. Our commitment goes beyond our patients-we prioritize the well-being, growth, and satisfaction of every team member. If you're looking for a place where your work makes a meaningful impact, Texas Oncology is the place for you.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

What does the Insurance Specialist do?

Under general supervision, is responsible for Monitoring Federal and Commercial credits to ensure they are compliant Refunds INS, Refund Patient credits, Review adjustments and postings. Follows standard procedures and pre-established guidelines to complete tasks Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

The essential duties and responsibilities:

• Maintain Federal credits - to ensure they are worked according to government guidelines - 60 days
• Maintain Commercial credits - to ensure they are worked within the 90 days and follow TXO policy and procedures
• Reviews payment postings for accuracy and to ensure account balances are current.
• Maintain Patient credits - transferring pt money - working the overpayment accordingly before refunding the patient.
• Monitoring spreadsheets to ensure all work is done before the end of month
• Monitors and updates management on problematic accounts that they need assistance with
• Verifies existing patients have necessary referral and/or authorization documentation prior to examination date
• Contacts and follows up with patients physician for any missing or incomplete documentation
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• May refer patients to Patient Benefits Representative to set up payment plans.
• Contacts third party payors to resolve payor issues, expedite claim processing, and maximize medical claim reimbursement.
• Reviews credits for accuracy of payment posting and billing errors.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records.
• Speaks with patients in regards to why they received a refund check, or asking for updated address information.
• Communication with Insurance companies for COB details, as well as duplicate payments, recoupment or any other details to resolve the overpayment.
  
• Performs other duties as requested or assigned.

The ideal candidate for the position will have the following background and experience:

Level 1

• High School diploma or equivalent required.
• Minimum two (2) years combined medical billing and payment experience required.
• Demonstrate knowledge of state, federal, and third party claims processing required.
• Demonstrate knowledge of state & federal collections guidelines.
• Must successfully complete required e-learning courses within 90 days of occupying position.

Level 2 (in addition to level 1 requirements)

• Minimum four (4) years combined medical billing and payment experience required
• Demonstrate knowledge of medical coding, preferably oncology coding

Level Sr (in addition to level 1 and 2 requirements)

• Associates degree in Finance, Business or four years revenue cycle experience preferred
• Minimum two (2) years insurance resolution experience resolving issues with patients and payers as well as four (4) years combined medical billing and payment experience required
• Proficiency with computer systems and Microsoft Office (Word and Excel) required
• Demonstrate knowledge of oncology medical coding
• Demonstrate knowledge of state, federal, and third party claims processing required

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to manipulate a computer keyboard and mouse. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent contact with staff. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to blood, toxic substances, ionizing radiation and other conditions common to a clinic environment.