Physician Billing Rep

Job Details

Job Description

PRIMARY RESPONSIBILITIES:

The Billing Coordinator for Oncology is responsible for reviewing and coding infusion charges for hospital billing and analyzing denial codes to determine the root causes. It also requires ensuring that infusion services align with payer guidelines, medical necessity, and regulations. Maintaining accurate records of denials, authorizations, and follow-up actions is essential, as well as serving as a point of contact for patients, providers, and insurance companies to resolve issues. The position demands staying up-to-date on insurance policy changes and payer rules, using problem-solving skills to address denied authorizations, and communicating with healthcare providers to secure necessary documentation. Additionally, the role includes supporting the reduction of billing lag times for the department and performing other duties as assigned, all while adhering to policies, procedures, and safety protocols.

The Billing Coordinator works with the Billing Manager and Business Manager to ensure adherence to all regulatory and HIPAA guidelines.

ESSENTIAL FUNCTIONS:

* Review and code infusion charges for submission to hospital billing.

* Analyze denial codes and documentation to identify the root cause of denials.

* Ensure infusion services comply with payer guidelines, protocols, and medical necessity requirements.

* Maintain accurate records of denials, authorizations, and follow-up actions.

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma

Must pass all required training for EPIC

CERTIFICATES, LICENSES, AND REGISTRATION:

Current CPC certification preferred.

EXPERIENCE REQUIREMENTS: Must be experienced with Excel

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.