Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, andtreatment facilitiesin Atlanta, Chicago and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

This role functions as the subject matter expert. The Lead is responsible for assisting the supervisor and staff with workload and productivity management as well as new employee training. This individual is also responsible for collaborating with other departments to continuously improve revenue cycle performance by identifying, communicating, and resolving issues with the supervisor. The Revenue Cycle Lead will also provide leadership and guidance to the staff through knowledge of the company’s internal policies and procedures in addition to industry standard billing and collection guidelines. The individual in this role works in a team environment to fulfill the mission and goals of the Division. This role is knowledgeable and supports the different functions within Revenue Cycle including but not limited to collections, data processing, payment posting, refunds, coverage validation and billing.

As a successful candidate, you will:

• Generates monthly work files for staff based on monthly review of volume and internal policies and procedures or as needed.
• Facilitates communications with payers to address outstanding claims, denials, or remits to resolve payment variances, and works to develop and maintain positive relationships with payers.
• Initiates communications with providers to address any outstanding issues impacting revenue; makes recommendations for resolving and/or improving the flow of data and maximizing charge capture.
• Reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle if necessary to resolve issues.
• Analyzes data to track and identify trends and provides team with updates and ideas for improvement.
• Assists staff in identifying high-risk accounts and prioritizing resolution efforts; Ensures staff is researching high dollar accounts, high volume denials, credits, adjustments, and undistributed balances, etc. in adherence to internal policies and procedures.
• Maintains superior understanding of CPT/HCPCS codes, ICD-10 codes, CMS 1500 form guidelines, eligibility and coverage requirements, remit and remark codes, payor/plan codes, claims management, third-party payer guidelines, state and federal regulations, claims clearinghouse workflow, and all other pertinent functions of the job.
• Has thorough knowledge of managed care contracts, DOFRs, reimbursement rates, and other billing requirements mandated by said agreements with payors.
• Collaborates with other departments to identify best-practice strategies, align goals, and improve collections.
• Ensures staff is working work queues in adherence to internal policies and procedures.
• Ensures that all necessary documentation and information is correct according to divisional policies and procedures for approval of charge corrections and refunds.

Your qualifications should include:

• High school diploma or equivalent.
• Minimum of seven (7) years of experience performing medical billing functions.
• Minimum experience includes corresponding with insurance companies in resolving patient accounts.
• Extensive knowledge of insurance carrier procedures, including Medicare, Medi-Cal and other third-party payors.
• Experience with reading Explanations of Benefits (EOB) statements.
• Proven ability to handle multiple conflicting tasks.
• Preferably: Associates or bachelor’s degree.

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity and inclusion, please click here.