Collections Associate

Children’s Hospital of Philadelphia•Philadelphia, PA

8d•$25 - $31

About The Position

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. Ability to work independently or as a member of a project team. This position could be assigned to hospital, professional or home care claims. Supports the CHOP mission with efficient and effective revenue cycle management.

Requirements

High School Diploma / GED Required
Demonstrated customer service skills, customer focus abilities and the ability to understand Children’s Hospital of Philadelphia customer needs. (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)
Demonstrated experience with multiple computer applications. (Required proficiency)
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)

Nice To Haves

Bachelor's Degree Preferred
At least one (1) year experience in billing, payment posting, operations, or related role Preferred
High proficiency in Microsoft Excel. (Preferred 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)

Responsibilities

Submits timely, accurate claims to insurance carriers according to insurance payor guidelines through established methods and procedures using current available technology.
Resolve 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.
Based on payer processes, utilize payer portals, paper/electronic remits and/or place calls to the payer to understand and resolve denials.
Perform adjustments as needed.
Identifying third party payor response trending and escalation to management team as deemed necessary.
Reviewing 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.
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.
Excellent oral and written communication skills with strong analytical skills.
Suggests ideas and solutions for performance and quality improvement and provides feedback to team leaders.
Demonstrates quality and effectiveness in work habits in every interaction with, colleagues, and leadership.
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.
Demonstrates behaviors that are consistent with CHOP’s organizational values of Integrity, Compassion, Accountability, Respect and Excellence (ICARE). 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. Provide 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.
Ability to communicate effectively and collaborate with teams across Patient Financial Services and other departments
Other duties as assigned within the scope of the responsibilities.