Payer and Medical Policy Coordinator

Children’s Hospital of Philadelphia•Philadelphia, PA

8d•Remote

About The Position

The Payer-Medical Policy Coordinator supports the Revenue Integrity team by conducting ongoing payer policy reviews, analyzing and interpreting rules to identify material impacts and ensure accurate billing, coding, and reimbursement. You’ll track and report all payer policy activity, act as a liaison between Revenue Integrity, Payment Integrity, hospital departments, and hospital-owned revenue-generating areas to ensure charges comply with payer policy, federal and state regulations while optimizing reimbursement. You’ll collaborate with Patient Financial Services to resolve denials tied to billed CPT/HCPCS/revenue codes linked to the CDM. This role includes daily maintenance of assigned work queues, supporting special projects as needed, and partnering across the revenue cycle—PFS, HIM, Case Management, Contracting and Reimbursement Services—so strong communication and the ability to interact effectively across the organization are essential. The ideal candidate is highly detail-oriented and maintains a clear, organized process to catalog all payer policies for easy recall and efficient application. This is an excellent opportunity for someone who thrives in a hospital setting and understands the complexities of payer policies and denial management. Apply today and help strengthen the financial health of our hospital system—while enjoying the flexibility of a fully remote role.

Requirements

Certified Professional Coder (CPC) - AAPC - upon hire - Required
Bachelor's Degree - Required
At least five (5) years related professional experience in a hospital patient financial services function - Required
Experience with coding, billing and CDM maintenance - Required
At least five (5) years related professional experience in a hospital patient financial services function - Required
Experience with coding, billing and policy maintenance
Strong database and analytic skills; working knowledge of key computer applications such as EPIC and Microsoft Office suite of products
Ability to promptly recognize, evaluate and manage multiple priorities.
Excellent organizational skills.
Ability to function efficiently and professionally with minimum supervision.
Ability to interact effectively across the organization
Ability to work independently, achieves specific goals and objectives, and provides recommendations for improvement
Ability to work collaboratively with a strong orientation for bottom line results.
Understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models.

Nice To Haves

Bachelor's Degree Clinical Field - Preferred
At least three (3) years prior supervisory experience - Preferred
Clinical experience - Preferred

Responsibilities

Payer Policy Maintenance
Coordinate monthly/periodic payer policy updates
New service/New Supply requests
Responsible for analyzing code denials
Responsible for coordinating periodic update meetings with key stakeholders
Establishes department standards of excellence.
Establishes integrated systems which improve services and support the Hospital's mission.
Develops, tests, implements and evaluates new and creative approaches to meeting departmental and institutional goals.
Integrates trends in healthcare and own profession to forecast future departmental and institutional needs for program development, space, and financial resources.
Responds promptly and positively to patients, families, associates, and all others in a respectful, courteous and confidential manner.
Follows hospital and department procedures and policies, including but not limited to patient safety, mandatory education, confidentiality, attendance, etc.