Job Description
** Please Note: Only Candidates with Oncology Experience will be considered at this time.
Department: Revenue Cycle Management – AR Follow-Up
Reports To: AR Manager
Status: Full-Time
Location: Remote
Position Summary
The Oncology AR Representative is responsible for the timely follow-up, resolution, and collection of outstanding insurance balances for medical oncology, infusion, and related services. This role requires strong knowledge of oncology billing, including drug and administration claims, high-dollar chemotherapy and biologic accounts, and complex payer requirements. The ideal candidate works independently, prioritizes accounts based on timely filing risk and denial type, and understands the financial impact oncology accounts have on the practice.
Key Responsibilities
- Work assigned AR work queues and aged accounts for medical oncology, infusion, and radiation oncology (as applicable), prioritizing by aging, timely filing deadlines, and denial risk.
- Follow up with commercial, Medicare, Medicare Advantage, and Medicaid payers via portals, phone, and clearinghouse to determine claim status and secure payment.
- Analyze and resolve oncology-related denials, including medical necessity, authorization and referral, coding and modifier edits, bundling, and drug billing discrepancies.
- Review claims for accurate HCPCS/J-codes, NDC reporting, units of service, and JW/JZ modifier requirements for drug waste.
- Verify that billed chemotherapy and infusion administration codes (e.g., 96413, 96415, and 96365–96379 series) are supported and sequenced properly.
- Identify and appeal underpayments by comparing remittances to contract terms and fee schedules, including drug reimbursement methodologies (e.g., ASP-based).
- Prepare and submit clean, well-supported appeals, including medical records, letters of medical necessity, and peer-to-peer requests when required.
- Coordinate with prior authorization, coding, charge entry, and clinical staff to resolve root-cause issues and prevent repeat denials.
- Handle clinical trial and research-related billing questions in coordination with the designated billing compliance contact (e.g., Medicare Clinical Trial Policy and QR/Q1/Q0 modifiers).
- Post accurate, detailed account notes for every interaction, including payer reference numbers, contact names, and next action dates.
- Process refunds, adjustments, and write-off requests according to policy and approval thresholds.
- Escalate trends, payer issues, and system or workflow problems to the AR Manager with supporting examples.
- Meet or exceed daily productivity, quality, and cash collection targets.
Required Qualifications
Minimum of 2 years of healthcare AR follow-up or denial management experience.
Medical Oncology AR experience is required.
Direct experience with medical oncology billing, insurance follow-up, and denial resolution.
Working knowledge of CPT, HCPCS, ICD-10, revenue codes, modifiers, and CMS-1500/UB-04 claim forms.
Familiarity with EOB/ERA/835 remittance interpretation and CARC/RARC denial codes.
Understanding of payer authorization, medical necessity, and appeal processes.
Experience with the Medisoft EHR billing system and payer portals.
Proficiency in Excel and Microsoft Office.
Strong analytical, organizational, and time management skills.
Clear written and verbal communication skills for payer interactions and internal collaboration.
High school diploma or equivalent.
Preferred Qualifications
- Experience with buy-and-bill drug billing, biosimilars, and oral oncolytics.
- Knowledge of 340B program billing considerations.
- Experience with LCD/NCD review for oncology therapies.
- Experience with clinical trial billing or Medicare Secondary Payer (MSP) issues.
- Experience managing large, high-dollar accounts.
Core Competencies
- Accuracy and Attention to Detail: Understands that small coding or unit errors on drug claims can have significant financial consequences.
- Persistence and Follow-Through: Works accounts through resolution rather than simply touching them.
- Critical Thinking: Identifies root causes rather than focusing only on individual claim fixes.
- Accountability: Takes ownership of assigned accounts and maintains thorough documentation.
- Professionalism: Represents the organization and its clients effectively with payers and internal partners.
Performance Expectations
- Meet daily account touch and productivity standards.
- Maintain a high level of documentation quality.
- Achieve cash collection and AR reduction goals established by leadership.
- Resolve high-risk timely filing accounts within established timeframes.
- Maintain compliance with HIPAA and organizational policies.
Work Environment
This is a fully remote position involving primarily computer-based work, extended periods of sitting, frequent phone contact with payers, and a fast-paced, metric-driven environment. Must maintain confidentiality of protected health information at all times.
