Proton Billing Specialist

Job Description:

The Proton Billing Specialist will be responsible for managing the billing process for proton therapy, radiation therapy, and radiology. The individual will need to have expertise in medical billing and coding, as well as a strong understanding of insurance reimbursement processes and regulations related to proton therapy, radiation therapy, and radiology services. The successful candidate will work closely with RCM leadership, patients, physicians, and insurance companies to ensure that accurate and timely billing is completed.

Responsibilities

• Review and verify patient insurance eligibility and benefits for proton therapy treatments.

• Verify that all applicable charges for proton therapy, radiation therapy, and radiology services are entered timely and accurately into the practice management system allowing for clean claim submission.

• Audit charges and communicate with clinical and RCM teams to resolve any outstanding/pending charges ensuring timely and accurate billing.

• Generate and submit accurate and timely claims for proton therapy, radiation therapy, and radiology services to insurance payers

• Delivers timely responses to emails and telephone messages as appropriate.

• Monitor and track claims through the entire billing process daily to ensure timely payment and identification of payer roadblocks.

• Assist with investigation and resolution of any claim rejections, denials, or appeals related to proton therapy treatments.

• Ability to review and interpret insurance guidelines and associated regulations relating to proton therapy treatments to ensure compliance with billing requirements.

• Work collaboratively with the proton therapy center's medical and pre-authorization teams to ensure accurate and complete billing for proton therapy and radiation therapy treatments.

• Maintain accurate and up-to-date records of billing activities in patient files and computer systems.

• Follows policies and procedures outlined by management to ensure standardization of processes.

• Ability to review and interpret radiation oncology medical records for accuracy as it relates to coding and billing.

• Educate clinical team on appropriate documentation requirements.

• Assist team members with responses to patient and insurance company inquiries about billing for proton therapy treatments in a timely and professional manner.

• Stay current with industry trends, changes to insurance coverage guidelines, and other developments that may impact the billing process for proton therapy and radiation therapy treatments.

• Recognizes problems or trends and provides suggestions to help find resolutions.

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

Key Competencies

• Strong knowledge of medical terminology and procedures related to proton therapy treatments and/or Radiation Oncology.

• Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid.

• Excellent verbal and written communication skills.

• Ability to work collaboratively with diverse groups of individuals, including physicians, patients, insurance providers, and interdepartmental teams.

• Strong organizational and time management skills.

• Ability to work independently and manage multiple priorities in a fast-paced environment.

• Proficiency in medical billing software and other computer programs used for record keeping and data analysis.

• Knowledge of Windows-based software applications. (E.g.: Word, Excel, Outlook…)

Qualifications

• High school diploma or equivalent required

• Bachelor’s degree preferred

• Minimum of 3 years' experience in medical billing and coding required, preferably in an Oncology based healthcare setting

• Radiation Oncology/Proton experience a plus