Revenue Cycle Coverage Validation Representative
Job Description
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:
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, please CLICK HERE.
Additional Information:
This position is represented by a collective bargaining agreement.
Salary / Pay Rate Information:
Pay Rate: $22.84 - $30.67 / hour
The estimated pay scale represents the typical [salary/hourly] range City of Hope reasonably expects to pay for this position, with offers determined based on several factors which may include, but not be limited to, the candidate’s experience, expertise, skills, education, job scope, training, internal equity, geography/market, etc. This pay scale is subject to change from time to time.
City of Hope is a community of people characterized by our diversity of thought, background and approach, but tied together by our commitment to care for and cure those with cancer and other life-threatening diseases. The innovation that our diversity produces in the areas of research, treatment, philanthropy and education has made us national leaders in this fight. Our unique and diverse workforce provides us the ability to understand our patients' needs, deliver compassionate care and continue the quest for a cure for life-threatening diseases. At City of Hope, diversity and inclusion is a core value at the heart of our mission. We strive to create an inclusive workplace environment that engages all of our employees and provides them with opportunities to develop and grow, both personally and professionally. Each day brings an opportunity to strengthen our work, leverage our different perspectives and improve our patients’ experiences by learning from others. Diversity and inclusion is about much more than policies and campaigns. It is an integral part of who we are as an institution, how we operate and how we see our future.
