Job Description

Insurance Denials Follow Up Rep

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

Hours: Mon - Fri Days

The Account Follow-up Rep (AFR) is responsible for the reimbursement and/or resolution of patient account balances and is accountable for complete follow-up tactics working accounts to exhaustion maximizing reimbursement.  This role performs account management and analysis; as well as complete, timely, and accurate follow up of patient or insurance (hospital or physician) account balances with the objective of optimizing insurance reimbursement and ensuring that our patients receive the best CTCA has to offer in account management.  An Account Follow-up Rep may be responsible for working account balances in any of the following areas: 

  • Insurance Account Follow-up (hospital or physician), which may include a focus on claims denied by insurance carriers or paid incorrectly (underpaid).
  • Self-pay Account Follow-up focusing on the collection of the patient responsibility portion left by insurance leveraging assistance programs and tools. This area includes the inbound call center.
  • Administration of financial programs supporting the patient with medical balances such as Financial Assistance, Co-pay Assistance, Free Drug, Drug Replacement, etc. 

The AFR interacts with, and leverages, external and internal sources to overcome barriers, problem solve, and ultimately resolve account balances. This includes patients, caregivers and family members, site stakeholders, contracted and non-contracted insurance, third party payers, and employers as necessary. They are expected to review and determine appropriate actions on assigned patient accounts at a minimum of every 45 days or as the collection process requires. 

This role is accountable for understanding and reconciling insurance practices (contracted/non-contracted).  
Confirming that a claim/account has been verified, billed, and paid correctly through analysis of payments and adjustments. The AFR will take the appropriate action to resolve claims that are not paid correctly as a result of denials or underpayment.  This position is also responsible for ensuring that account statements are accurate and timely and with the appropriate statement message; that patients have an understanding of their balances and are appropriately engaged in appeals with insurance.  The AFR provides assistance options to support patients with their financial responsibility where appropriate. 


 

Education/Experience Level

  • Must have a high school diploma/equivalent or passed proficiency exam.
  • Associates degree in related field is preferred.  BA/BS is desired.
  • Must have a minimum of 3 years of A/R experience in a hospital or physician healthcare setting including insurance and self-pay healthcare collections/billing as well as insurance verification experience with demonstrated analytical capability.

Knowledge and Skills

  • Solid knowledge of medical terminology, ICD9 codes, CPT/HCPC’s codes. Familiar with Medicare Bad Debt laws and requirements, and Fair Debt Collection Laws.
  • Understanding of insurance contracts and reimbursement methodologies. 
  • Experience with account reconciliation and balancing.  
  • Ability to interpret EOBs and navigate insurance patient insurance policies.
  • Knowledge of collection agency work, probate courts and its requirements, and bankruptcy laws and regulations.
  • Advanced written and verbal communication skills.
  • Proficient with technology, spreadsheet management skills, with the ability to analyze trends.
  • Excellent organizational skills, ability to manage multiple priorities and responsibilities. 
  • Outstanding communication and customer service skills.
  • Must be willing to travel, as needed

#AF-HJ


 

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. 

Visit:  Jobs.cancercenter.com to begin your journey.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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