Revenue 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.

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.