Oncology Billing Representative

Responsibilities

• Monitor and review daily pre-certification work queues in collaboration with the HQ Pre-Certification Department to ensure timely processing and resolution of outstanding items.
• Identify, investigate, and assist in resolving claim edits, billing discrepancies, and missing documentation to facilitate accurate and timely claim submission.
• Serve as the primary liaison between the practice and HQ Billing Department, participating in monthly billing meetings and communicating key findings, trends, and recommendations to the Practice Administrator.
• Manage and resolve Charge Posting Hold Bucket issues by correcting provider and nursing documentation errors and ensuring appropriate drug billing and diagnosis code alignment.
• Submit hospital charges through the pMD system in accordance with established policies and procedures.
• Verify referrals and manage Referral Hold Buckets to ensure all necessary approvals and documentation are obtained prior to services being rendered.
• Complete pre-registration activities, including insurance verification and benefit review, before patient appointments to support efficient patient access and reimbursement processes.
• Provide cross-coverage for pre-certification and authorization responsibilities during staff absences to maintain uninterrupted patient care and revenue cycle operations.
• Serve as a billing resource for patients by addressing insurance and billing-related questions and collaborating with HQ Billing to facilitate issue resolution.
• Maintain a thorough understanding of payer requirements, oncology-related services, medications, and approved diagnosis codes to support revenue cycle accuracy and compliance.

Qualifications

• A high school graduate or equivalent.
• Minimum three years experience in a medical business office setting.
• Oncology experience preferred.

Benefits

• Health, dental, and vision plans.
• Wellness program.
• Health savings account - Flexible spending accounts.
• 401(k) retirement plan.
• Life insurance.
• Short-term disability insurance.
• Long-term disability insurance.
• Employee Assistance Program (EAP).
• Paid Time Off (PTO) and holiday pay.
• Tuition discounts with numerous universities.