Job Description

Revenue Cycle Representative (Accounts Receivable)

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:

Job Summary/Purpose:

Denials and Appeals Specialist (DAS) specialize in follow up of denied claims from all commercial and contracted payers. DAS’s are responsible to perform timely and appropriate validation and follow up denied claims, including the initial assessment of the denials received via the denials management systems queue (XDM) to determine the appropriate course of action for resolving the claims.  DAS’s thoroughly investigate denied claims to ensure timely and proper follow-up for addressing denials including assigning them to the appropriate resources within the denials and appeals management workflow, collaborating with the Clinical Appeals Program Manager to initiate the appeals process, and coordinating with the Insurance Claims Representative (ICR) and/or Accounts Management Specialist (AMS) to complete research to support the claim review and to determine and execute the appropriate course of action for resubmission of the claims to obtain reimbursement.  The DAS is also responsible for supporting the development of business processes for managing the denials and appeals process at CTCA.  They will provide system and process support to the broader multi-functional Denials and Appeals resources.  The DAS will support and administer training for XDM (the denials management technology) and participate in system support activities. The Denials and Appeals Specialists report directly to the Manager of Denials and Appeals.

Job Responsibilities

1. (50%)

  • Is specialized in third party payer follow up regarding denied claims.
  • Works assigned daily work queue or work assignment reports as defined by management in accordance with Patient Accounts policies and procedures.
  • Research denied claims to understand reason and identify the appropriate course of action.  Contact insurance companies for the purpose of verifying denial reason and confirming the additional information required.
  • Execute on the course of action required for re-processing claims to obtain reimbursement or identify and escalate to the appropriate clinical resources.
  • Collaborate within the Patient Accounts team (verifications, billing, and ICR, AMS, CARS) to complete research regarding denied claims.
  • Escalate claims to the Clinical Appeals Program Manager to initiate the appeal process and provide necessary support.
  • Provide analytical support regarding denials trends 
  • Identifies questionable accounts/bills, problematic payers or unusual situations and brings to leadership.
  • Works extensively with denials management technology

2. (25%)

  • Possesses a solid knowledge of current ICD coding methodology and ultimately ICD10, CPT/HCPS codes, EOB’s, State and Federal insurance coding regulations, and FDCPA.  
  • Is responsible for a high volume of daily insurance contacts and timely follow up on assigned accounts.
  • Resolve and respond to insurance correspondence - verbal and written resulting in significant claims reimbursement.
  • Prepares rebill requests as appropriate.
  • Understands contract terms of reimbursement for managed care, government and third party payers, insuring correct claim adjudication.
  • Participates in the development and the ongoing support of denials and appeals management programs and processes
  • Provides training and troubleshooting regarding processes and technology

3. (10%)

  • Capable of operating all required computer applications and maintains accurate patient demographics, patient confidentiality, and insurance information and routinely updates account comments of each account worked.
  • Proficient in A/R and billing applications.
  • Is proficient in running and printing of appropriate reports and accurate logging functions necessary to maintain productivity.
  • Maintains this level of competency and productivity with additional systems as conversions occur.

4. (10%)

  • Alerts manager and supervisor of questionable situations, pattern denials or any situations resulting in delayed claim resolution, billing or potential financial loss to the corporation.
  • Communicate insurance and coding updates to manager and coworkers as appropriate.

5. (5%)

  • Attends department, team and Stakeholder meetings and in-services or seminars as requested.
  • At all times adheres to written CTCA, and Patient Accounts specific policies and procedures, including Safety and Security procedures, 5S standards, CTCA Financial Policy and all HIPAA rules and regulations.
  • Is flexible, organized and is able to meet deadlines as necessary.
  • Maintains satisfactory QA’s.

Education/Experience Level

  • Must be a High School graduate or equivalent
  • Strong analytical skills.
  • College Degree Preferred.
  • Must have minimum of 1-2 years experience in registration, collection and verification in a healthcare setting or similar service profession.

Knowledge and Skills

  • Must have strong analytical and troubleshooting skills
  • Must have experience with account reconciliation and balancing
  • Must have excellent organizational skills, be highly productive and able to manage multiple priorities.
  • Must have good written and verbal communication skills.
  • Must have basic knowledge of medical terminology.
  • Knowledge of PC and other office equipment with Windows experience.
  • Must have experience with current ICD coding methodology, insurance terminology and ability to read an Explanation of Benefits.
  • Must have outstanding telephone communication and customer service skills.
  • Must be efficient, reliable, goal oriented and adaptable to change while maintaining productivity levels.
  • Must be able to perform routine mathematical, color coding and alphabetizing functions.
  • Must be Team oriented.
  • Must be courteous and professional.
  • Must be willing to travel as needed

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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