Insurance Specialist II

Texas Oncology is seeking a full-time Insurance Specialist to support the Medical Oncology Department in Richardson, Texas. This role is part of The US Oncology Network, which delivers high-quality, evidence-based cancer care to patients close to home. Texas Oncology is the largest community oncology provider in the country, with approximately 530 providers across 280+ sites in Texas. Our mission is to use leading-edge technology and research to deliver exceptional cancer care, helping patients achieve “More breakthroughs. More victories.” in their fight against cancer.

About the role

This position is located at 3001 E. President George Bush Highway, Suite 100, Richardson, Texas. The typical workweek consists of eight hours per day between 7:30 AM and 5:30 PM.

Responsibilities

• Monitors delinquent accounts and performs collection duties.
• Reviews reports, researches, and resolves issues.
• Reviews payment postings for accuracy and ensures account balances are current.
• Works with co-workers to resolve insurance payment and billing errors.
• Monitors and updates delinquent accounts status.
• Recommends accounts for collection or write-off.
• 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.
• Maintains credit balances of patients and payors, ensuring timely refunds within government guidelines and regulations.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records.
• Performs other duties as requested or assigned.

Requirements

• Level 1:
  • High school diploma or equivalent required.
  • Minimum two (2) years combined medical billing and payment experience required.
  • Demonstrated knowledge of state, federal, and third-party claims processing required.
  • Demonstrated knowledge of state and federal collections guidelines.
  • Must successfully complete required e-learning courses within 90 days of occupying the position.
• Level 2 (in addition to Level 1 requirements):
  • Minimum four (4) years combined medical billing and payment experience required.
  • Demonstrated knowledge of medical coding, preferably oncology coding.
• Level Sr (in addition to Level 1 and 2 requirements):
  • Associate’s degree in Finance, Business, or four years of revenue cycle experience preferred.
  • Minimum two (2) years of 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.
  • Demonstrated knowledge of oncology medical coding.
  • Demonstrated knowledge of state, federal, and third-party claims processing required.

Skills

• Uses Technical and Functional Experience: Possesses up-to-date knowledge of the profession and industry; accesses and uses resources when appropriate.
• Demonstrates Adaptability: Handles day-to-day work challenges confidently; adjusts to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Customer Service: Demonstrates positive interpersonal relations with employees, supervisors, physicians, patients, and outside contacts to maximize productivity and positive relations.
• Uses Sound Judgment: Makes timely, cost-effective, and sound decisions, even under conditions of uncertainty.
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
• Commits to Quality: Emphasizes delivering quality products and services; defines and evaluates standards for quality; improves efficiencies.

Physical Demands

• Regularly required to sit and use hands to manipulate a computer keyboard and mouse.
• Occasionally required to stand, walk, and reach with hands and arms.
• Must occasionally lift and/or move up to 30 pounds.
• Requires vision and hearing corrected to normal ranges.

Work Environment

• Work is performed in an office environment with frequent contact with staff.
• Regular exposure to direct contact with patients, with potential for exposure to blood, toxic substances, ionizing radiation, and other conditions common to a clinic environment.