The Triage/Order Quality Associate I (TOQI) will be responsible for the accurate and timely work of filing insurance claims for Exact Sciences. This role will demonstrate medical insurance knowledge by determining initial and/or ongoing eligibility, coverage, and related insurance reimbursement order details, including commercial, government, and all various plan coverage. This role will identify order and reimbursement deficiencies, route orders for appropriate actioning, and document actions taken within the systems for claims lifecycle tracking. This role will also support the broader activities of ensuring appropriate coverage by utilizing Epic, external portals, and other software, and communicate insurance information to ancillary departments and other teams within the reimbursement operations departments.
Essential Duties and Responsibilities
Maintain confidentiality and adhere to all HIPAA guidelines/regulations.
Determine initial or ongoing patient insurance eligibility verification for all claims, including commercial and government insurance to the plan coverage and product level.
Investigate and correct accounts within Epic and other systems/tools, including updates to patient demographics, financial information, and guarantor information.
Interact with various insurances/third party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
Research missing or erroneous information on accounts using various portals and other resources, including outreach and identification of unknown payors.
Stay current with relevant medical billing regulations, rules, and guidelines.
Provide ad-hoc support within the department for special projects and outages/high volume events.
Complete position responsibilities within the appropriate time frame while adhering to quality standards.
Ability to communicate effectively with all levels of staff through both verbal and written communications.
Ability to work in a team environment and adapt to changing workload and circumstances effectively; able to respond to new information quickly.
Ability to act in a professional manner in all interactions with members of the Exact Sciences clinical laboratory team, clients, and associates.
Ability to work with others in a spirit of teamwork and cooperation.
Excellent problem-solving abilities and organizational skills.
Disciplined, self-motivated and reliable; able to stay focused on a task and work independently; motivated to perform quality work; diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
Possess a positive attitude.
Ensure compliance with all Company procedures and guidelines; including, but not limited to, Code of Business Conduct and Ethics.
Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
Support and comply with the company's Quality Management System policies and procedures.
Maintain regular and reliable attendance.
Ability to act with an inclusion mindset and model these behaviors for the organization.
Ability to work designated schedule.
Ability to work overtime, as needed.
Ability to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
You will be required to successfully complete an assessment showing understanding of Exact Sciences Epic processes necessary to the job functions with a score of 80% or higher. Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement.
Qualifications
Minimum Qualifications
High School Diploma or General Education Degree (GED).
3+ months of experience in any healthcare field.
Strong knowledge of order management, insurance claims procedures, electronic health record (EHR) operating systems.
Basic knowledge of medical terminology and/or health insurance terms.
Demonstrated strong attention to detail and focus on quality output.
Proficient with electronic health records.
Proficient in Microsoft Office programs, such as Word and Outlook.
Demonstrated ability to perform the essential duties of the position with or without accommodation.
Authorization to work in the United States without sponsorship.
Preferred Qualifications
Associates Degree in field as outlined in the essential duties.
1+ years of experience in the medical or insurance billing field.
Experience in revenue cycle platform applications.
Medical billing certification.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, creed, disability, gender identity, national origin, protected veteran status, race, religion, sex, sexual orientation, and any other status protected by applicable local, state, or federal law. Applicable portions of the Company's affirmative action program are available to any applicant or employee for inspection upon request.
