Contract Adherence Specialist

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 Contract Adherence Specialist will be responsible for managing and maintaining fee schedule related aspects of Payer Reimbursement, including securing, loading, and auditing contracted fee schedule data for accuracy. In addition, this position will assist in identifying and resolving underpayment related issues for all applicable payers.

Responsibilities:

• Knowledgeable and proficient in Claims billing procedures CPT and HCPCS codes

• Demonstrates and applies expert level of knowledge of revenue cycle processes and concepts

• Interpret contract reimbursement

• Maintains documentation for contractual reimbursement for payers.

• Maintains data in appropriate database

• Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.

• Performs account audits

• Manages payer log spreadsheets to be submitted to the health plans.

• Identify trends in underpayments

• Research and identify payment discrepancies from various sources

• Performs reviews and assessments for underpaid claims

• Compile and analyze data for recovery

• Manage underpayment appeals and account follow-up

• Resolve underpaid claims in an effective and timely fashion

• Reports dollars and recovery efforts routinely to management

• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualifications:

• High School diploma or equivalent required.

• Minimum five (5) years’ experience in accounts receivable, healthcare, or managed care preferred.

Essential Competencies:

• Attendance is an essential job function.

• Detailed knowledge of billing, HCPCS, CPT and ICD codes. Previous collections experience preferred

• Exceptional Multi-tasking, organizational skills and attention to detail

• Works well under deadlines and time sensitive projects while maintaining accuracy

• Strong numeric and analytical skills

• Self-motivated, able to work autonomously, multi-task and switch focus quickly

• Excellent verbal and written communication skills

• Strong knowledge of Windows-based software applications (E.g. Word, Excel, Outlook, Access)

• Must possess high degree of professionalism and adaptability.

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