Collections Associate - Physician Billing

About the role

Primarily responsible for timely resolution of low complexity patient accounts. Assigned duties include researching account balances, following up with collection calls to insurers and parents, reviewing claims, and resolving denials.

Responsibilities

• Submits timely, accurate claims to insurance carriers according to insurance payor guidelines through established methods and procedures using current available technology.
• Resolves patient insurance balances by analyzing denials and using critical thinking skills and knowledge of payer requirements to determine the steps needed to obtain payment.
• Work in either No Pay No Response, Denial work queues, or both.
• Utilize payer portals, paper/electronic remits and/or place calls to the payer to understand and resolve denials.
• Perform adjustments as needed.
• Identify third party payor response trending and escalate to management team as deemed necessary.
• Review data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts.
• Prioritize assigned work based on department needs and direction from leadership team.
• Follow workflows to route accounts to other CHOP departments (Case Management, Medical Records, Credit Resolution, Billing, Abstraction, Clinical Teams, Coding etc.) to address denials.
• Advise supervisor of contractual issues as discovered.
• Place phone calls, sends email or written communication to families to resolve denials that require intervention from the guarantor.
• Document each account thoroughly, explaining action taken on the account and completing note template provided.
• Files appeals on behalf of the patient to resolve denials.
• Reviews and acts on correspondence for assigned accounts.
• Identifies trends in assigned work queues and reports to leadership.
• Works accounts holistically, building on the last intervention and not repeating tasks.
• Identifies patients with multiple denials and works from a guarantor level to resolve issues completely for a family.
• Completes projects as assigned for specific payers or specific types of accounts, ensuring deadlines are met.
• Suggests ideas and solutions for performance and quality improvement and provides feedback to team leaders.
• Interfaces well with all levels of staff and management.
• Maintains all PHI in accordance with HIPPA, JACHO, third party contractual agreements along with CHOP policy and procedures.
• Ensures work is performed, relationships are built, responsibility is assumed, and service delivered expresses the CHOP’s values through action.
• Able to communicate effectively and collaborate with teams across Patient Financial Services and other departments around operational efficiencies.
• Provides recommendations for corrective action to management team to ensure efficiency of the revenue cycle.
• Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
• Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations.
• Able to communicate effectively and collaborate with teams across Patient Financial Services and other departments.
• Other duties as assigned within the scope of the responsibilities.

Requirements

• High School Diploma / GED Required.
• Bachelor's Degree Preferred.
• At least one (1) year experience in billing, payment posting, operations, or related role preferred.
• Demonstrated customer service skills, customer focus abilities and the ability to understand Children’s Hospital of Philadelphia customer needs.
• Ability to work cooperatively in a team environment.
• Demonstrated effective interpersonal, verbal, and written communication skills.
• Knowledge of Microsoft Office applications including Word, Excel.
• Demonstrated experience with multiple computer applications.
• HIPAA compliance standards.
• Effective communication, interpersonal skills, analytical skills, and problem solving skills.
• Excellent organizational and time management skills.
• Detail and results oriented.
• High aptitude for math.
• Excellent writing and oral communication skills.
• Able to work independently and prioritize work.
• Basic Computer skills.
• High proficiency in Microsoft Excel (preferred).
• Knowledge of third-party reimbursement and physician/hospital billing (preferred).
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems (preferred).
• Experience with Epic systems (preferred).

Qualifications

• Education Qualifications: High School Diploma / GED Required. Bachelor's Degree Preferred.

Skills

• Customer Service Skills
• Customer Focus Abilities
• Interpersonal Communication Skills
• Verbal Communication Skills
• Written Communication Skills
• Microsoft Office Applications (Word, Excel)
• Computer Applications
• HIPAA Compliance Standards
• Effective Communication
• Interpersonal Skills
• Analytical Skills
• Problem Solving Skills
• Organizational Skills
• Time Management Skills
• Math Skills
• Writing Skills
• Independent Work
• Prioritization
• Basic Computer Skills
• Microsoft Excel Proficiency
• Third-Party Reimbursement Knowledge
• Epic Systems Experience

Benefits

Not specified.

Pay

SALARY RANGE: $25.50 - $31.85 Hourly

Schedule

Not specified.