Rep, Account Follow Up
Company: Cancer Treatment Centers of America
Location: Zion
Posted on: May 12, 2022
Job Description:
Job Description
Rep, Account Follow Up
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:
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 (expected reimbursement).
- Administration of financial programs supporting the patient
with medical balances such as Financial Assistance, Co-pay
Assistance, Free Drug, Drug Replacement, etc.
- 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 and outbound follow-up.
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 a minimum of every 45 days or as the collection
strategy/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 VP Finance, 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.
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 required. Higher balances accounts may require more frequent
follow-up, and the AFR will determine based on circumstances to
touch an account multiple times within the month as needed.
- Responsible for managing a portfolio of patient accounts with
multiple touch points over an extended time period.
- Pursues insurance companies, patients or guarantors, PPO
Networks, attorneys as appropriate for the purpose of expediting
payment of CTCA receivables.
- 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 underpaid 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.
- 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.
- Responsible for timely and accurate documentation in applicable
systems.
- Works all incoming mail, 3rd party correspondence, and inbound
call center. 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 require financial assistance with their patient responsibility
balances. 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).
- Responsible for identifying and recommending process
improvements; and are assigned special projects or assignments from
AM Supervisor or Director as requested.
- Accountable to productivity metrics associated with account
reduction, collection metrics, and account aging.
2. Account Analytics
- Maintains current and complete understanding of 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.
Account Management
- Through account follow-up reconciles complete patient history,
routinely adds statement messages, sends letters, and makes
outbound calls as appropriate and establishes patient's payment
plans.
- Ensures account financial class is accurate, and updates as
appropriate based upon actions taken and approvals are obtained
where appropriate.
- 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.
- Implements the terms of financial programs in support of
patients (financial assistance, copay assistance, free drug, drug
replacement).
- Approves adjustment of uncollectable balances or recommends for
approval based upon guidelines established in the Patient Accounts
A/R Policy.
4. Relationship/Communications
- 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
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.
Keywords: Cancer Treatment Centers of America, Kenosha , Rep, Account Follow Up, Other , Zion, Wisconsin
Didn't find what you're looking for? Search again!
Loading more jobs...