Revenue Cycle Coverage Validation Representative

About City of Hope

City of Hope is an independent biomedical research and treatment organization 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 subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope's specialized 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.

City of Hope's commitment to Diversity, Equity and Inclusion

We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds and perspectives; this is reflected in our work and represented in our people.

Key Responsibilities include:

• 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.

Basic education, experience and skills required for consideration:

• 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:

• 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.
• 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.

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.

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