Senior Collection Associate - Pharmacy

About the role

Primarily responsible for timely resolution of low complexity patient accounts. Assigned duties include researching account balances and following up with collection calls to insurers and parents. Reviewing claims with no response. Reviewing denied claims or underpaid claims and resolving the denial and filing appeals, as necessary. Ensuring all information pertaining to collection activity is fully and accurately documented in the patient accounting system. Works to identify payment and denial trends for timely resolution. Works to identify internal and external causes of denials for timely resolution.

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.
• Works in either No Pay No Response, Denial work queues, or both.
• Based on payer processes, utilizes payer portals, paper/electronic remits and/or places calls to the payer to understand and resolve denials.
• Performs adjustments as needed.
• Able to manage daily job functions along with special project work and prioritize level of importance on demand.
• Identifies third party payor response trending and escalates to management team as deemed necessary.
• Reviews data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts.
• Prioritizes assigned work based on department needs and direction from leadership team.
• Placed phone calls, sends email or written communication to families to resolve denials that require intervention from the guarantor.
• Documents each account thoroughly, explaining action taken on the account and completing note template provided.
• Gathers Medical Records, using ROI, to assist in resolving denials as needed.
• Filings appeals on behalf of the patient to resolve denials.
• Reviews and acts on correspondence for assigned accounts.
• Position requires adherence to production and quality metrics.
• 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.
• Ensures work is performed, relationships are built, responsibility is assumed, and service delivered expresses the CHOP’s values through action.
• Ability 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.

Requirements

• At least two (2) years experience in billing, payment posting, operations, or related role.
• At least three (3) years experience in billing, payment posting, operations, or related role.

Qualifications

• High School Diploma / GED - Required.
• Bachelor's Degree - Preferred.

Skills and Abilities

• HIPAA compliance standards (Required proficiency).
• Effective communication, interpersonal skills, analytical skills, and problem solving skills. (Required proficiency).
• Excellent organizational and time management skills. (Required proficiency).
• Detail and results oriented. (Required proficiency).
• High aptitude for math. (Required proficiency).
• Excellent writing and oral communication skills. (Required proficiency).
• Ability to work independently and prioritize work. (Required proficiency).
• Basic Computer skills (Required proficiency).
• High proficiency in Microsoft Excel. (Required proficiency).
• Demonstrated customer service skills, customer focus abilities and the ability to understand Children’s Hospital of Philadelphia customer needs. (Required proficiency).
• Maintain high-level knowledge of claim submission requirements. (Required proficiency).
• Ability to work cooperatively in a team environment. (Required proficiency).
• Demonstrated effective interpersonal, verbal, and written communication skills. (Required proficiency).
• Knowledge of Microsoft Office applications including Word, Excel. (Required proficiency).
• Must maintain 10-key by touch. (Required proficiency).
• Demonstrated experience with multiple computer applications. (Required proficiency).
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Required proficiency).
• Knowledge of third-party reimbursement and physician/hospital billing. (Preferred proficiency).
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Preferred proficiency).
• Experience with Epic systems (Preferred proficiency).