Revenue Cycle Coverage Validation Representative

City of Hope • Irwindale, CA

5d

About The Position

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.

Requirements

• 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

Nice To Haves

• Experience with medical groups or Independent Practice Associations (IPA) with specific knowledge of medical EOBs/ERAs/HCFA

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED