The Radiation Billing Specialist is responsible for a variety of office and clerical tasks relating to insurance billing, claims processing, insurance follow-up, insurance appeals, and patient payment arrangements.
- Perform complex reviews and advanced clinical abstraction of Radiation Oncology services, including simulation, dose distribution treatment planning, and treatment delivery modality and complexity
- Assign CPT, HCPCS, and ICD-10 codes across radiation therapy modalities including 3D CRT, IMRT, Proton Therapy, Brachytherapy, and SRS (Gamma Knife)
- Validate treatment parameters, including monitor units, gantry angles, and control points, to ensure coding accuracy
- Reconcile physician prescriptions with delivered treatments to ensure alignment of technical and professional charges
- Review and validate KV imaging, CBCT imaging, and supporting documentation for compliant billing
- Complete end-of-course chart audits to ensure full charge capture and documentation completeness
- Resolve charge review, claim edit, and denial work queues within Epic
- Analyze denial trends related to CCI edits, MUE limitations, medical necessity requirements, and bundling issues
- Implement corrective actions to reduce denials and improve reimbursement outcomes
- Prepare appeal documentation and collaborate with payer teams to support claim resolution
- Identify systemic revenue cycle issues and recommend workflow or documentation improvements
- Ensure billing practices align with annual industry updates, including ASTRO billing standards
- Educate clinical teams regarding documentation requirements needed to support all submitted charges
- Maintain current knowledge of regulatory updates, including ASTRO and CMS rule changes
- Communicate effectively with physicians and clinical staff to provide education and feedback regarding coding and documentation issues
- Ensure compliance with CMS, NCCI, MUE, and payer-specific billing guidelines
- Identify compliance risks and escalate issues appropriately
- Bachelor's Degree Business Administration, Hospital Administration or related field preferred or equivalent years of experience in Radiation Billing.
- 3 years billing, coding, or cost accounting experience to include two years in a medical service environment, insurance or related field.
- Strongly proficiency in medical billing software, electronic health records (EHR), payer guidelines, and detailed data analysis.
