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REVENUE CYCLE COVERAGE VALIDATION REPRESENTATIVE - 10034176
Irwindale, CACity of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases.
Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a wholly owned subsidiary, was launched in 2019 and is dedicated to serving employers and their health care partners by providing access to City of Hope’s exceptional cancer expertise.
A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation’s “Best Hospitals” in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona.
Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.
As a successful candidate, you will:
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Responsible for daily management of registration and insurance related errors in the following EMR modules:
Charge Review
Claim Edit
Follow Up
Retro Review
Remittance
Registration and coverage validation for all new COH patients received via manual charge capture process.
As requested by internal departments, re-verify insurance information and/or coordination of benefits, to confirm eligibility and coverage via payors website or phone call.
Notifies other pertinent COH staff regarding health care coverage changes for billing correction purposes, while maintaining a positive and collaborative manner interactions with colleagues and others.
Responds timely and accurately to all incoming correspondence from payors, patients, and other COH departments.
Reports trends related to system and/or workflow issues to management team, in an effort to identify root cause and resolution.
Initiate recommendations and take action, when appropriate, in resolving complex patient account issues related to coverage/eligibility.
Collaborates with Revenue Cycle Collectors for submission of corrected claims, and/or communicates with Refund Clerks for payment recoupment, and/or completes Registration for manual charge entry.
Works independently and is able to organize and prioritize workload with limited to no supervision.
Your qualifications should include:
High school diploma
Two (2) to five (5) years of experience in a hospital, medical group or Independent Practice Association (IPA).
Has thorough knowledge of HMO, PPO, POS coverage rules.
Medical terminology and EMR experience
Preferably: Experience with medical groups or Independent Practice Associations (IPA) with specific knowledge of medical EOBs/ERAs/HCFA
City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.
City of Hope is an equal opportunity employer. To learn more about our Comprehensive Benefits, pleaseCLICK HERE.
Additional Information:
This position is represented by a collective bargaining agreement.