Clinical Trials Billing Specialist

Children’s Hospital of Philadelphia•Philadelphia, PA

3d•$30 - $39•Hybrid

About The Position

The billing specialist will facilitate accurate billing for patients enrolled in clinical trials in accordance with federal regulations to reduce both institutional and individual provider legal and financial risk. They will ensure that both professional and hospital claims include correct identifiers and are compliant with government regulations with special attention to CMS guidelines as they pertain to billing for patients enrolled in clinical trials. In conjunction with Clinical Trials Financial Management who handles the first tier, this role will serve as the second tier review for the two-tier billing process to confirm charges will be routed to the appropriate funding source based on the linked clinical trial protocol in both Epic and OnCore (CTMS system).

Requirements

Knowledge of clinical trial billing review processes
Ability to interpret clinical trial protocols in Epic and OnCore
Experience with clinical trial claim edits and identifiers
Ability to identify and resolve research-related billing denials
Strong attention to detail and regulatory compliance knowledge
Effective analytical and problem-solving skills
High School Diploma / GED Required
At least three (3) years of work experience in healthcare billing or collections environment or other related role. Required
Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely Required
Strong math aptitude (Required proficiency)
Excellent organizational skills. (Required proficiency)
Clear and concise decision making skills (Required proficiency)
Leadership skills (Required proficiency)
Detail oriented (Required proficiency)
String interpersonal skills (Required proficiency)
Excellent writing and oral communication skills (Required proficiency)
Ability to work independently; results oriented (Required proficiency)
Ability to handle confidential matters. (Required proficiency)
Flexibility to work overtime as needed/required (Required proficiency)
Experience with personal computers including Excel (Required proficiency)

Nice To Haves

Bachelor's Degree Preferred
At least one (1) year of coding experience Preferred
Experience with Epic system (Preferred proficiency)
Certified Coding Specialist (CCS) - AAPC, AHIMA - upon hire - Preferred or
Certified Coding Specialist-Physician-Based (CCS-P) - AAPC, AHIMA - upon hire - Preferred or
Certified Professional Coder (CPC) - AAPC, AHIMA - upon hire - Preferred or
Certified Professional Coder Apprentice (CPC-A) - AAPC, AHIMA - upon hire - Preferred

Responsibilities

Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
Monitors work queues assigned as their responsibility, meeting established production and quality standards for the assigned tasks.
Identify trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
Stays current on regulations and industry standard trends to ensure CHOP is compliant.
Responsible for creating presentation and data analytics to drive change and improvements.
Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.
Other duties as assigned.