SHIFT:
Day (United States of America)Seeking Breakthrough Makers
Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.
At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.
CHOP's Commitment to Diversity, Equity, and Inclusion
CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.
We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.
A Brief Overview
Under the supervision of the Collection Manager, this individual is responsible for timely resolution of patient accounts. Assigned duties include collection calls to parents and insurers, payor relations and financial management of accounts receivable.
What you will do
- Reviews remittance advices (RAs) and explanation of benefits (EOBs) of assigned payors/accounts.
- Reviews accuracy of RAs/EOBs on a weekly basis; contacts payors to resolve inappropriate denials/rejections.
- Works with other CHOP departments (ie: Case Management, Medical Records, Credit and Billing) to appeal legitimate denials.
- Advises supervisor of contractual problems on a weekly basis.
- Resolves patient accounts billed to insurance payers or directly to the guarantor.
- Conducts at least 60 daily telephone calls or accesses Payer website to insurances and/or responsible party to inquire on status of claims.
- Sends and receives payor correspondence via mail and/or fax on a daily basis.
- Utilizes account work queues to expedite resolution of outstanding accounts.
- Completes 90% of work list (or other mutually agreed percentage) on a weekly basis.
- Reviews account work queues for thoroughness and applicability to workload with supervisor on a monthly basis.
- Maintains complete, accurate and up-to-date account history for each account.
- Reviews appropriateness of account balances (ie:allowances, late charges, duplicate charges, insurance and patient balance, etc) on a monthly basis.
- Enters comments in account notes system for all patient accounting activity.
- Escalate individual problem accounts to Supervisor or Manager.
- Identify payer trends for denials
- Preparation for Payer meetings.
- Maintains orderly filing system.
- Coordinates medical record requests and audit request of payors.
- Submits requests for medical records within two working days.
- Refers bills and audits to internal auditor on a weekly basis archiving on a weekly basis.
- Performs other duties as assigned.
Education Qualifications
- High School Diploma / GED Required
- Bachelor's Degree Preferred
Experience Qualifications
- Healthcare experience and/or claims processing, billing, collections or customer service experience preferred
- 1 year of physician/professional or hospital accounts receivable collections experience preferred
Skills and Abilities
- Must have the ability to follow through with any patient financial problems until they are adequately resolved.
- Good working knowledge of third party insurance and public assistance programs.
- Good working knowledge of hospital computer information systems (ie: SMS IDX or EPIC).
- Must have excellent organizational, written and verbal communication skills.
To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.
Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.
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