Claims Specialist

One. Oncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive One. Oncology’s mission and vision.

Why join us? This is an exciting time to join One. Oncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, 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 independent physicians and the patients they serve.

Job Description: Essential Duties and Responsibilities Work assigned insurance accounts receivable for unpaid, underpaid, and denied Medical Oncology claims. Review accounts to determine why claims have not been processed or paid appropriately. Research claim status using payer portals, electronic systems, remittance information, EOBs/ERAs, and payer communication.

Identify and resolve denials involving: Medical necessity Prior authorization Eligibility and coverage Timely filing Coding and modifier issues Diagnosis-related denials Duplicate claims Coordination of benefits Missing or invalid information Non-covered services Bundling or reimbursement issues Correct and resubmit claims when appropriate.

Prepare and submit payer reconsiderations and appeals with applicable supporting documentation. Follow up on previously submitted appeals and reconsiderations through final payer determination. Review reimbursement to identify potential underpayments and discrepancies between expected and received payment. Work Medical Oncology claims involving infusion/administration services and physician-administered medications, including claims utilizing HCPCS J-codes.

Research payer policies and requirements when necessary to determine the appropriate resolution for a claim. Document all account activity clearly and accurately, including claim status, denial reason, action taken, payer communication, and next follow-up step. Meet established productivity, quality, and account follow-up expectations.

Escalate payer trends, recurring denials, system issues, or other barriers affecting reimbursement to leadership. Collaborate with billing, coding, authorization, clinical, and other revenue-cycle departments as needed to resolve outstanding accounts. Identify patterns and root causes contributing to avoidable denials and communicate findings to leadership.

Maintain compliance with HIPAA, organizational policies, payer requirements, and applicable healthcare billing regulations.