Rev Cycle Coverage Validation Representative

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.
• Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan.  Practices a high level of integrity and honesty in maintaining confidentiality.
• Performs other related duties as assigned or requested.

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

Additional Information:

• As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.
  
• This position is represented by a collective bargaining agreement
• 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 committed to creating a diverse environment and is proud to be an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.