Insurance Denials Follow Up Rep
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:
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.
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.
Leveraging all available account follow-up and analysis options the AFR may ultimately determine that account balances are uncollectable. This can be through bad debt adjustment, month end review with the site CFO, or leveraging patient financial assistance programs.
The AFR is considered an agent acting on behalf of the patient, as well as CTCA, and therefore must exemplify the highest in CTCA standards to ensure a consistently positive patient experience. Serves as a direct point of contact for CTCA patients and regularly fields patient inquiries and complaints.
The Account Follow-up Rep reports directly to the Account Follow-up Supervisor.
1. Account Follow-up and Collections
- Works assigned alpha, or account strategy as communicated by the Supervisor via the Account Trial Balance (ATB) and supporting systems (PIC).
- Follow-up is completed on accounts/patients monthly or as directed based upon account follow-up strategy. Higher balances accounts may require more frequent follow-up, and the AFR will make a determination based on circumstances to touch an account multiple times within the month as the collection process requires.
- Responsible for managing a portfolio of patient accounts with multiple touch points over an extended period of time.
- Pursues insurance companies, patients or guarantors, PPO Networks, attorneys as appropriate for the purpose of expediting payment of CTCA receivables.
- Accountable to productivity metrics associated with account reduction, collection metrics, and account aging.
- May be responsible for follow-up on denied charges, utilizing CTCAs denials management technology, accessing denials via their work queue. This includes validation of denied charges, collaboration with site resources to ensure denials are appealed timely, regular payer follow-up regarding appealed account, medical records requests, and any short paid claim in an effort to obtain correct reimbursement expected.
- When appropriate, will identify opportunities to negotiate with insurance in an effort to ensure fair and optimal reimbursement.
- Responsible for identifying and recommending process improvements; and are assigned special projects or assignments from AM Supervisor or Director as requested.
- Refer accounts/bills to Recovery Service Representatives for the purpose of filing and/or following up on liens, worker comp claims, litigation, collection issues etc.
- Updates insurance information and routinely adds account comments to each account worked.
- Responsible for timely and accurate documentation in applicable systems.
- Works all incoming mail, 3rd party correspondence, and inbound call center if necessary and are available to provide back up if required to do so. All mail should be reviewed within 1 business day of receipt and any time sensitive issues must be addressed by the end of the business day.
- All other correspondence worked by end of month, unless other authorization has been granted by supervisor or director as appropriate.
- Through account follow-up identifies accounts where patients may be in need of assistance with their patient responsibility balances. The AMS is responsible for providing the patient with the appropriate information regarding the Financial Assistance program, determining eligibility, and communicating approval; as well as noting and updating the account appropriately.
- Discounts may be offered to patients for full payment of patient responsibility balances, or discounts may be offered to patients to settle their patient responsibility balances prior to assistance being offered (applicable to patients with non-government payers).
2. Account Analytics
- Maintains current and complete understanding of general contract terms of reimbursement from managed care, government and third party payers.
- Ensures that the terms of contract are met, and reimbursement is accurate.
- Maintain the skill sets to perform verification of insurance coverage, to calculate payments received are equal to what is expected based on contract rates and patients benefit coverage as needed.
- Performs research of incorrect payments, discounts and audits.
- Is responsible for analyzing EOB’s and determining if payment is correct.
- Completes thorough account research and communicates regularly with multiple internal and external entities to bring accounts to resolution.
- Identifies questionable accounts/bills, problematic payers or unusual situations and brings to supervisor or director.
- Will identify and escalate any payer trends identified to resolve and/or mitigate issues.
- Negotiates prompt pay discounts within guidelines established in CTCA AR and Billing policy, responds to all negotiation calls and faxes within 2 business days, unless other authorization has been granted as appropriate. Provides account background information in support of requests that must be escalated for approval.
3. Account Management
- Through account follow-up reconciles complete patient histories, routinely adds statement messages, sends letters, and makes out bound calls as appropriate and establishes both internal payment plans and extended time pays.
- Assigns account to in-house, extended time pay, collection agency, appropriate denials management work queue’s and litigation once identified, by the end of business day as appropriate, unless other authorization has been granted.
- Brings requests to transfer accounts/bills out of bad debt status to supervisor for review.
- Make recommendations for write-offs, litigation, and collection agency submission.
- Reviews account details and submits the electronic adjustment log to shared drive the end of the business day, unless other authorization has been granted.
- Prepares cash transfer requests.
- Maintains solid knowledge of operating all required computer applications and other systems as conversions may occur.
- Maintains relationships within Patient Accounts, RCM, and with Patients and Caregivers. Collaborates as needed with Care Managers, Pre-cert staff, Registration staff, Medical Records staff, Compliance.
- Active collaboration is required across all Patient Accounts functions to ensure that accounts are appropriately managed.
- This role may occasionally have contact with attorneys, county courts, insurance companies etc. for the purpose of collecting hospital and physician accounts/bills receivables.
- Serves as the primary point of contact with CTCA patients regarding their accounts. This includes self-pay balance follow-up, coordination of benefits (COB), responding to patient inquiries, etc.
- All patient calls must be returned within one business day and written requests within 3 business days. Are responsible to report any instances to their supervisor where they cannot meet these required time deadlines.
- Meets with patients as required (either in office or in hospital environment).
- Responsible for maintaining accurate patient demographics, patient confidentiality.
- Attends department, team, stakeholder meetings and in-services or seminars as requested.
- Adhere to written CTCA, and Patient Accounts/bills specific policies and procedures, CTCA Financial Policy and all HIPAA rules and regulations at all times.
- Demonstrates the spirit of CTCA’s values and standards through actions and speech and connect with patients, caregivers, co-works, payers with a smile or pleasant demeanor while also addressing them by their preferred names whenever possible.
- 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
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.
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.