Research Charge Analyst I

Children’s Hospital of Philadelphia•Philadelphia, PA

10d•Onsite

About The Position

This role is responsible for prompt and accurate review of claims in the research billing work queue. Responsible for ensuring that patient charges sent to the research billing queue are sorted and sent appropriately as defined by the Research Billing Plan to either insurance carriers or the research study. Identifies when issues need resolution by the Charge Review Manager and participates in issue resolution. This position is also responsible for providing executive level administrative assistance to the Clinical Research Finance Management office in all aspects of the Departments operations. Serves as a point of contact for clinical research study teams in areas related to research subject registration, providing training on use of the electronic research subject tracking system and resolving issues when they arise. Supports the Department in various functions that ensure SOPs are followed related to billing and research compliance. Collaborates with key department personnel for issue resolution regarding registration, scheduling and billing issues - serves as first point of contact to resolve various questions and issues posed by study team members. May include working with medical records, following HIPPA guidelines.

Requirements

High School Diploma / GED Required
At least one (1) year of experience in patient registration / customer service Required
Basic proficiency with office software (Microsoft Office)
Familiarity with electronic medical records systems (EPIC)
Familiarity with research database systems (EPIC)
Basic knowledge of research billing activities
Familiarity with HIPAA regulations
Familiarity with medical terminology
Strong verbal and written communications skills
Strong interpersonal skills
Strong customer service skills
Solid critical thinking / problem-solving skills
Solid analytical skills.
Ability to maintain confidentiality and professionalism
Ability to gather, analyze and make recommendations/decisions based on data
Ability to convey complex or technical information in an easy-to-understand manner
Ability to collaborate with stakeholders at all levels

Nice To Haves

Associate's Degree Preferred
Previous experience in Healthcare, registration, Physician billing, or medical records/office Preferred

Responsibilities

Responsible for reviewing and resolving Research charge issues (40%)
Inpatient/Outpatient Research vs. Insurance, must ensure compliance in Research Billing.
Claim analysis of all Research charges for Hospital and physician billing. Make determination to approve charges to Research or third party biller.
Review accounts weekly for potential adjustments, and facilitate those adjustments and insurance company reimbursement to avoid compliance violation fines.
Troubleshoot problem accounts with Investigators, Study Teams, Research, and Hospital personnel.
Support and train study team members in subject registration and scheduling; Register research subjects and encounters appropriately; trouble shoot issues (40%)
Registers and schedules research subjects in EPIC and ensures encounters are linked to research guarantors so that insurances are not charged for research procedures
Responds to phone calls and emails for the department and performs administrative duties to maintain the overall operating function of research registration and charge review
Creates and/or updates patient records by verifying demographic and proper study identification in the registration system.
Performs any other duties necessary to provide efficient, timely services to patients and their families as it relates to the research registration and billing process.
Maintains consistent and productive communication with necessary departments and study teams to resolve issues relating to research registration and billing
Answers general information questions regarding procedures and services (e.g. current studies, study specific information, contact lists, etc.) and appropriately directs calls within the department and institution.
Maintains a working knowledge of current departmental procedures and services and is able to answer questions regarding insurance, registration, and other services.
Responsible for monitoring and measuring the accuracy and integrity of data entered into the registration and scheduling system as well as act as a liaison with other departments to identify quality improvement and training needs.
Works with Management in identifying trends and opportunities to enhance the pre-visit, registration and scheduling functions for patients/subjects and department staff.
Provide executive level administrative support to the CTFM Department (20%)
Attends start up meetings to review and communicate registration and scheduling responsibilities of study team members.
Responsible for serving as a liaison to study teams and research subjects utilizing the research subject participant reimbursement program (PRC) managed by the Department.
Ensures eligibility and compliance to PRC program SOPs in place.
Performs billing charge entry duties for the Department. Under direction of the Charge Review Manager enters billing charges into EPIC for programs set up for special charge entry sessions.
Resolves any registration, billing and charge entry issues with Manager; makes recommendations for edits or process changes when necessary.
Serves as first point of contact via phone or email to resolve various questions and issues posed by study team members. Strives to resolve questions or issue without Manager's involvement. Must be able to handle a large volume of calls and direct them appropriately and efficiently.
Monitors CTFM email inbox. Resolves issues/questions when appropriate or distributes email to appropriate CTFM staff or inbox. Follows up with CTFM staff on resolution of issues.