Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Coding Denials Specialist is responsible for completing coding related denial management for outstanding claims. The Coding AR Specialist will also help develop appeal templates for common coding related denials. Additional responsibilities include identifying and preparing patient and insurance refunds, completing necessary claim corrections, reviewing claims for any necessary adjustments, as well as assist with inbound phone calls to the department.

Key Responsibilities

• Research and resolve outstanding claim denials in a timely manner.

• Follow up on outstanding AR within a timely manner.

• Identify coding errors and make necessary coding corrections independently.

• Review clinical documents and patient records to determine accurate medical codes (CPT, ICD-10, HCPCS) for diagnoses, treatments, and procedures.

• Write and submit appeal letters and include supporting documentation when needed for reconsiderations, and/or appeals for outstanding claims.

• Prepare all necessary documentation required for patient and/or insurance refunds and overpayments identified.

• Identify trends in incorrect coding and work with management to provide necessary feedback to the coding team.

• Complies with all applicable guidelines including but not limited to NCCI guidelines, NCDs, LCDs, payor guidelines, and all other coding related guidance.

• Monitors payor guidelines for updates to policies.

• Answers inbound phone calls related to outstanding AR.

• Other duties as assigned to help drive our mission of improving the lives of everyone living with cancer.

Requirements and Qualifications

• High school diploma or equivalent required.

• CPC or CCS certification required.

• Minimum of 2 years healthcare administration or revenue cycle management experience.

• Knowledge of insurance and medical terminology.

• Experience with EMR/practice management systems (eClinical Works preferred) and payor websites

• Excellent patient service skills.

• Excellent organizational skills and attention to detail.

• Regular and timely attendance.

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

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