Insurance Verification

About City of Hope,
City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the U.S., and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked top 5 in the nation for cancer care by U.S. News & World Report at its core, City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. 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 cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas.

The successful candidate:

The Advocate, Patient Access Rep reviews and evaluates a prospective and current patient’s insurance coverage after obtaining the benefits from an interview process of over 40 detailed questions with the patient’s insurance payer and uses the quoted benefit information to facilitate a decision regarding a patient’s eligibility to be treated at CTCA while insuring that the CTCA Patient Financial Acceptance policy and specific site exception policies are applied, and determines when a patient should be escalated to site CFO’s for Administration Approvals. The Advocate, Patient Access Rep documents individual patient benefits into the database repositories for insurance data which serve as the databases for communicating benefit information to both prospective and current patients and for insuring accurate and complete billing, correct reimbursement rates, pre-certification requirements, and maximized collections. This position communicates daily with OIS, OIS Leadership, Care Managers, Registration Stakeholders, Pre-Certification Coordinators, Site CFO’s, Site VP’s of Finance, Billers, CAR’s, PACR’s and Account Management Specialists and reports directly to the Advocate, Patient Access Supervisor.

Job Accountabilities

• Verifies all new patient verifications distributed daily via new patient queue
• Completes return verifications daily for verifications distributed via the return patient work queue, e-mails and any incoming Sharepoint requests.
• Obtains benefits through a multi-question interview process or by utilizing an online portal. Benefits are obtained for hospital and physician services for inpatient and outpatient settings for both in and out of network coverage.
• Documents all information obtained and actions taken for each record in appropriate systems.
• Verifies returning patients for continued benefit evaluation per established guidelines in the financial policy to guard against policy changes or terminations/cancellations.
• Completes a required minimum of records per day.  Provides daily counts via e-mail, and submits daily work per guidelines
• Email-Referred or Sharepoint Verifications: 15 records per day
• Evaluates and estimates insurance policy coverage while adhering to the written Patient Financial Acceptance Policy, specific site exceptions by insurance payer, alert list and HIPPA guidelines.
• Performs initial financial screens through policy interpretation to maximize reimbursement and minimize the exposure of uncollectible balances.
• Interprets and communicates insurance benefits based on the different insurance plans, types and groups to OIS, Physicians and support staff, Care Managers, Site CFO’s and VP’s of Finance, Billing, Registration and PACRs.
• Completes Administration Exceptions for escalated patients and specific alert listed payers.
• Verifies whether or not Medicare exists via online verification tools; document information obtained in appropriate systems for each patient verified. 
• Sends Journey Book tasks or emails to all required personnel regarding: site administration exceptions, benefits changes, coverage termination, and special pre-certification requirements. 
• Advises Supervisor, Director or Vice President of any updates needed to the insurance verification alert list and any other noticeable insurance trends.

Education/Experience Level

• Must be a high school graduate or equivalent with strong analytical skills and good figure aptitude. Associates Degree preferred.
• Recommended minimum of 1-3 years experience in insurance verification, insurance benefits, registration, billing and/or collection, in a healthcare / physician office setting or professional environment.
• Preferably possesses basic knowledge of medical terminology,
• Preferably possesses good written and verbal communication skills,
• Must have experience utilizing PC and other office equipment; must have good working knowledge of Operating Systems to include Microsoft Office Suite.
• Prefer ICD-9, CPT coding, and ability to read Explanation of Benefits.
• Highly recommend understanding and experience with insurance terminology
• Must have outstanding telephone communication and customer service skills. 

City of Hope is an equal opportunity employer.

To learn more about our comprehensive benefits, click here: Benefits Information

City of Hope employees pay is based on the following criteria:  work experience, qualifications, and work location.