Insurance 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 Management Specialist (AMS) manage the CTCA patient financial experience as the analytical and relationship arm of the Patient Accounts lifecycle. This role performs account management and analysis; as well as complete, timely, and accurate follow up on both hospital and physician account balances with the objective of optimizing reimbursement and ensuring that our patients receive the best CTCA has to offer in account management.
The AMS 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. The AMS function is directly responsible for approximately 30% of ongoing cash flow and therefore, is expected to review and determine appropriate management actions on assigned patient accounts at a minimum of every 45 days or as the collection process to resolution requires. Through the account follow-up and analysis process the AMS will recommend final resolution for account balances that cannot be collected. This can be through adjustment, month end review with the site CFO, or collection/litigation.
The AMS must be able to utilize a holistic approach to managing a patient account from the time it is received through to resolution. The AMS 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. Must be capable of understanding and reconciling that an account has been verified, billed, and paid correctly. Must be capable of analyzing account payments and adjustments. Ensures account statements are accurate and timely and with the appropriate statement message. Fields patient inquiries and complaints on a daily basis. The Account Management Specialist reports directly to the Account Management Supervisor. (AM Supervisor)
Account Follow-up and Collections
- Works assigned alpha, or account strategy as communicated by the AM Supervisor via the Account Trial Balance (ATB).
- AMS duties include performing follows up on accounts/bills at a minimum of every 45 days and insurance claims at $75k and over every 30 days, or as the collection process to resolution requires.
- AMS pursues insurance companies, patients or guarantors, PPO Networks, attorneys as appropriate for the purpose of expediting payment of CTCA receivables.
- AMS are responsible for managing a portfolio of patient accounts with multiple touch points over an extended period of time.
- AMS are held accountable to productivity metrics associated with account reduction, collection metrics, and account aging.
- 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, AMS will identify opportunities to combine accounts into single case agreements in an effort to ensure a fair and optimal reimbursement.
- AMS are responsible for identifying and recommending process improvements; and are frequently assigned special projects or assignments from AM Supervisor or Director as requested.
- AMS 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 within the denials management technology as well as AMPFM.
- The AMS works all incoming mail, 3rd party correspondence, daily cash sheets, 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 Hardship program and application; as well as noting and updating the account appropriately.
- 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. AMS 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.
- AMS also performs researching of: incorrect payments, illegal discounts and audits.
- Is responsible for analyzing EOB’s and determining if payment is correct.
- Complete 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.
- The AMS 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.
- 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.
- AMS make recommendations for write-offs, litigation, and collection agency submission.
- AMS 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.
- AMS maintains site relationships, and collaborates regularly 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.
- The AMS is 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. The AMS 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).
- AMS will function as a resource to PACR’s and ICR’s for questions relating to collection action and or written correspondence work.
- 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.
- AMS must be able to demonstrate 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.
- Finds ways to focus solely on the needs of our patients and caregivers to ensure their understanding.
- Offers choices to patients and caregivers and respects their decisions.
- The AMS department utilizes Kaizen and Smart Goal techniques to insure effectiveness of workflow.
Education and Experience
- Must have a high school diploma/equivalent or passed proficiency exam, with strong analytical skills.
- Associates degree in related field is desirable.
- BA/BS is preferred.
- Must have a minimum of 3 years or greater A/R experience in a hospital or physician healthcare setting which will include insurance and self-pay healthcare collections/billing as well as insurance verification experience.
Knowledge and Skills
- Must have excellent organizational skills, and be able to manage multiple priorities and responsibilities.
- Must be efficient, reliable, flexible, goal oriented and adaptable to change; while maintaining high productivity levels.
- Must have outstanding communication and customer service skills.
- Must have solid knowledge of medical terminology, ICD9 codes, CPT/HCPC’s codes.
- Must have advanced written and verbal communication skills.
- Must have minimum two-years of basic computer use and background.
- Must have strong analytical skills and must be able to perform routine mathematical, color coding and alphabetizing.
- Must have experience with account reconciliation and balancing.
- Must have knowledge of collection agency work, probate courts and its requirements, and bankruptcy laws and regulations.
- Must be familiar with Medicare Bad Debt laws and requirements
- Must have knowledge of the Fair Debt Collection Laws.
- Must be team oriented.
- Must be courteous and professional
- 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.