Accounts Receivable Specialist – RACH Billing
Children »s Hospital of Philadelphia Posted on 2022-11-18
| Salary | Not mentioned |
|---|---|
| Location | Philadelphia, PA 19104 (University City area) |
| Type | Full-time |
Job Description
Location: LOC_CIRA-Cira Centre
Req ID: 230093
Shift: Days
Employment Status: Regular – Full Time
Seeking Breakthrough Makers
Children’s Hospital of Philadelphia (CHOP)—named America’s 2022 Best Large Employer by Forbes—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.
Job Summary
This role is responsible for AR follow-up of assigned payers. Assist supervisor in reference to distribution and reviewing of special projects and weekly/daily assignments. Must set a positive example for team members and act as the initial resource for problem solving. Must be able to handle potential stressful situations as well as multiple tasks at one time. Must be a positive role model for staff members and work with them to promote teamwork and cooperation. Must work within their team to continually improve accuracy and efficiency.
Job Responsibilities
- Accounts Receivable Follow-up with assigned payers.
- Maintains Accounts Receivable goals of assigned payers including AR days and % of AR greater than 90 days
- Ensure all edit and rejection reports Paper or electronic are completed and appropriate action was taken.
- Inform Supervisor of any discrepancies related to billing and/or insurance companies on a weekly or immediate basis when a crisis may arise.
- Informs management of any payer trends
- Responsible for special projects for assigned payers
- Responsible for ensuring complete reviews of claims, identifies and researches any problems and forwards to appropriate insurance company.
Job Responsibilities (Continued)
- Responsible for completing review of electronic claim rejections for assigned payers
- Responsible for reviewing claims for rejection, pending or accepted status of assigned payers
- Rejected claims are to be reviewed by the A/R representative for appropriate follow-up.
- Responsible for ensuring appropriate action is completed within the same business day and returned.
- Any issues with claims pending, or remitted are to be reported to the Supervisor immediately
- Responsible for review of appropriate action for completed refunds/credit balances.
- Responsible for reviewing and assuring appropriate action of a completed refund to an insurance company or responsible party.
- Responsible to enter approved refunds/offsets with the appropriate action code within one (1) business day of receipt. When this is complete forward to receptionist or designee to enter the detail information in the appropriate offset or refund spreadsheet log for tracking purposes.
- Continue to maintain expected measures and standards of an Account Representative
- Inform Supervisor of all outstanding and unresolved issues related to billing or insurance companies on a weekly basis, or immediately if necessary.
Job Responsibilities (Continued)
- Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was rejected or question why a claim was not processed.
- Does all necessary follow up to obtain payment of claims; including but not limited to, claim status and intervention
- Reviews entire accounts to ensure claims were billed properly, payments were applied correctly and all necessary adjustments were made 100% of the time.
- Gathers all necessary documentation needed in order to have claims paid.
- Informs supervisor of any problems that arise 100% of the time.
- Records all pertinent comments and follows up accordingly, always following the guidelines set forth by management.
- Documents each contact in accordance with department guidelines
- Responsible for denial management for assigned payors; this will include review, follow up and escalation to management as required. Responsible for preparing, submitting and follow up of appeals for assigned payors.
Required Education and Experience
Required Education: High School diploma/GED
Required Experience: Two (2) years of billing experience.
Additional Technical Requirements
- Intermediate knowledge of insurance billing requirements for third party payors.
- Intermediate proficiency with office software (Microsoft Office)
- Intermediate proficiency with billing software (Microsoft Office)
- Familiarity with electronic medical records systems (EPIC)
- Solid verbal and written communications skills
- Solid analytical skills
- Solid critical thinking / problem-solving skills
- Ability to maintain confidentiality and professionalism
- Ability to work independently with minimal supervision
- Ability to gather, analyze and make recommendations/decisions based on data
- Ability to convey complex or technical information in an easy-to-understand manner
- Ability to collaborate with stakeholders at all levels
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, professionals working onsite—at any CHOP location, for any portion of time—must be vaccinated for COVID-19. Learn more.
CHOP also requires employees who work in patient care buildings to receive an annual influenza vaccine. Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.
EEO / VEVRAA Federal Contractor | Tobacco Statement
Company description:
At Children »s Hospital of Philadelphia (CHOP), we help children grow and thrive — and we offer these same opportunities to the professionals who make up our team. CHOP is a unique work environment, with exceptional team members, supportive managers and state-of-the-art training. Our employees are all empowered to realize their well-defined goals, because we believe everyone makes a difference — it’s the very foundation on which our hospital is built. Since 1855, CHOP has been the birthplace of many dramatic firsts in pediatric medicine. As the nation »s first hospital devoted exclusively to caring for children, CHOP has fostered medical discoveries and innovations that have improved pediatric healthcare and saved the lives of countless children. Today, that same spirit of care and innovation continues. The hospital now employs more than 10,000 people in more than 50 locations across Pennsylvania and New Jersey.
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