Oncology Insurance Specialist

POSITION:  Insurance Specialist

LOCATION: Cincinnati, OH

WEEKLY HOURS: 40

OHC – Specialists in Cancer and Blood disorders, is seeking a full time insurance specialist to work out of our Wooster Road office in Cincinnati, Ohio.  This position will transition to a remote schedule.  As the only independent adult cancer program in the region, we offer Medical, Radiation, Blood and Marrow Transplant, Gynecologic, and Breast Surgical Oncology services.  OHC supports a robust cancer research and clinical trials program, neuro-oncology, cancer genetics specialists and supportive care program.

The Insurance Specialist handles all radiation related billing including authorizations, clinicial coordination, delinquent accounts, payment and billing errors and collections.

OHC has been fighting cancer on the front lines for more than 38 years. We are now one of the nation’s largest independent oncology practices, as well as the region’s premier source of treatment for nearly every form of adult cancer and complex blood disorder. At its heart, our approach to cancer care is simple – to surround our patients with everything they need so they can focus on what matters most: beating cancer!

Why choose OHC?  

You take care of our patients, so we take care of you. OHC’s benefits include:

• 3 Health Insurance Plans to choose from 
• 2 Dental and 2 Vision insurance plans 
• A company matched 401K plan
• Profit sharing plan for clinical employees
• Competitive salaries
• Company paid short term / long term disability / life insurance 
• Paid Holidays 
• A generous PTO plan 
• Tuition Reimbursement 
• Professional Development Program
• Nationwide Discounts at your favorite hotels, resorts and retailers just for being an OHC employee
• Wellness Program
• Yearly merit raises 
• Opportunities for advancement

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Monitors delinquent accounts and performs collection duties
• Reviews reports, researches and resolves issues
• Reviews payment postings for accuracy and to ensure 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.
• 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/regulations
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient record
• Radiation authorization and clinical coordination
• Reviewing radiation oncology treatment plans and supporting documentation
• Securing authorization prior to CT simulation and treatment start
• Coordinating urgent/same-day treatment start cases
• Collaborating with physicians, dosimetry, scheduling, and radiation teams
• Monitoring authorization validity across multi-fraction treatment courses
• Managing radiation-specific peer-to-peer reviews, reconsiderations, and appeals
• Escalating cases that place treatment timelines at risk
• Performs other duties as requested or assigned

MINIMUM QUALIFICATIONS
• High School diploma or equivalent required
• Minimum two (2) years medical billing and payment experience in oncology 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

COMPETENCIES
• 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
• Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change
• Shows resilience in the face of constraints, frustrations, or adversity
• Demonstrates flexibility
• Customer Service
o Demonstrates positive interpersonal relations in dealing with fellow employees, supervisors, physicians, patients as well as outside contacts so that productivity and positive employee/patient relations are maximized.
• Uses Sound Judgment
• Makes timely, cost effective, and sound decisions
• Makes decisions 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 the need to deliver quality products and/or services
• Defines standards for quality and evaluates products, processes, and services against those standards
• Manages quality
• Improves efficiencies

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 will be offered 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 will be offered 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.