Insurance Verification 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
The Advocate, Patient Access Rep reviews and evaluates a prospective and current patient’s insurance coverage after obtaining the benefits from an interview process of over 40 detailed questions with the patient’s insurance payer. The Advocate, Patient Access Rep uses the quoted benefit information to facilitate a decision regarding a patient’s eligibility to be treated at CTCA while insuring that the CTCA Patient Financial Acceptance policy and specific site exception policies are applied. The Advocate, Patient Access Rep determines when a patient should be escalated to site CFO’s for Administration Approvals. The Advocate, Patient Access Rep documents individual patient benefits into the database repositories for insurance data which serve as the databases for communicating benefit information to both prospective and current patients and for insuring accurate and complete billing, correct reimbursement rates, pre-certification requirements, and maximized collections. The Advocate, Patient Access Rep communicates daily with OIS, OIS Leadership, Care Managers, Registration Stakeholders, Pre-Certification Coordinators, Site CFO’s, Site VP’s of Finance, Billers, CAR’s, PACR’s and Account Management Specialists. The Advocate, Patient Access Rep reports directly to the Advocate, Patient Access Supervisor.
- Verifies all new patient verification's distributed daily via new patient queue
- Completes return verification's daily for verification's distributed via the return patient work queue, e-mails and any incoming SharePoint requests.
- Obtains benefits through a multi-question interview process or by utilizing an online portal. Benefits are obtained for hospital and physician services for inpatient and outpatient settings for both in and out of network coverage.
- Documents all information obtained and actions taken for each record in appropriate systems.
- Verifies returning patients for continued benefit evaluation per established guidelines in the financial policy to guard against policy changes or terminations/cancellations.
- Completes a required minimum of records per day. Provides daily counts via e-mail, and submits daily work per guidelines.
- New Patient Verification's: 15 records per day
- Returning Patient Verification's: 20 records per day
- Email-Referred or SharePoint Verification: 15 records per day
- Evaluates and estimates insurance policy coverage while adhering to the written Patient Financial Acceptance Policy, specific site exceptions by insurance payer, alert list and HIPPA guidelines.
- Performs initial financial screens through policy interpretation to maximize reimbursement and minimize the exposure of uncollectible balances.
- Interprets and communicates insurance benefits based on the different insurance plans, types and groups to OIS, Physicians and support staff, Care Managers, Site CFO’s and VP’s of Finance, Billing, Registration and PACRs.
- Completes Administration Exceptions for escalated patients and specific alert listed payers.
- Verifies whether or not Medicare exists via online verification tools; document information obtained in appropriate systems for each patient verified.
- Sends Journey Book tasks or emails to all required personnel regarding: site administration exceptions, benefits changes, coverage termination, and special pre-certification requirements.
- Advises Supervisor, Director or Vice President of any updates needed to the insurance verification alert list and any other noticeable insurance trends.
- Must be a high school graduate or equivalent with strong analytical skills and good figure aptitude. Associates Degree preferred.
- Recommended minimum of 1-3 years experience in insurance verification, insurance benefits, registration, billing and/or collection, in a healthcare / physician office setting or professional environment.
Knowledge and Skills
- Preferably possesses basic knowledge of medical terminology,
- Preferably possesses good written and verbal communication skills,
- Must have experience utilizing PC and other office equipment; must have good working knowledge of Operating Systems to include Microsoft Office Suite.
- Prefer ICD-9, CPT coding, and ability to read Explanation of Benefits.
- Highly recommend understanding and experience with insurance terminology
- Must have outstanding telephone communication and customer service skills.
- Must be able to perform routine mathematical, color coding and alphabetizing functions.
- 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 be team oriented and able to work independently.
- Is capable of operating all required computer applications (CRM, AMPFM, Hyland OnBase, Pivot), office equipment and maintains accurate patient demographics per HIPPA guidelines, insurance information, and routinely updates CRM notes or AMPFM account comments of each record worked.
- Is able to recognize and have a general understanding of cancer diagnoses, contract terms, insurance terminology (IE: Coordination of Benefits, Letter of Credible, and Medical Review), reimbursement methods, and payer structures.
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
Visit: Jobs.cancercenter.com to begin your journey.