Research Charge Analyst I

Children's Hospital of Philadelphia

1d•Onsite

About The Position

This role is responsible for the prompt and accurate review of claims in the research billing work queue. It ensures 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. The position identifies when issues need resolution by the Charge Review Manager and participates in issue resolution. Additionally, this position provides executive-level administrative assistance to the Clinical Research Finance Management office in all aspects of the Department's operations. It serves as a point of contact for clinical research study teams regarding research subject registration, providing training on the electronic research subject tracking system, and resolving issues when they arise. The role supports the Department in various functions to ensure SOPs are followed related to billing and research compliance. It collaborates with key department personnel for issue resolution regarding registration, scheduling, and billing issues, serving as the first point of contact to resolve various questions and issues posed by study team members. This may include working with medical records and following HIPAA guidelines.

Requirements

High School Diploma / GED
At least one (1) year of experience in patient registration / customer service
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
Previous experience in Healthcare, registration, Physician billing, or medical records/office

Responsibilities

Reviewing and resolving Research charge issues, ensuring compliance in Research Billing.
Performing claim analysis of all Research charges for Hospital and physician billing.
Making determinations to approve charges to Research or third-party biller.
Reviewing accounts weekly for potential adjustments, and facilitating those adjustments and insurance company reimbursement to avoid compliance violation fines.
Troubleshooting problem accounts with Investigators, Study Teams, Research, and Hospital personnel.
Supporting and training study team members in subject registration and scheduling.
Registering research subjects in EPIC and ensuring encounters are linked to research guarantors so that insurances are not charged for research procedures.
Responding to phone calls and emails for the department and performing administrative duties to maintain the overall operating function of research registration and charge review.
Creating and/or updating patient records by verifying demographic and proper study identification in the registration system.
Performing any other duties necessary to provide efficient, timely services to patients and their families as it relates to the research registration and billing process.
Maintaining consistent and productive communication with necessary departments and study teams to resolve issues relating to research registration and billing.
Answering general information questions regarding procedures and services (e.g., current studies, study specific information, contact lists, etc.) and appropriately directing calls within the department and institution.
Maintaining a working knowledge of current departmental procedures and services and being able to answer questions regarding insurance, registration, and other services.
Monitoring and measuring the accuracy and integrity of data entered into the registration and scheduling system.
Acting as a liaison with other departments to identify quality improvement and training needs.
Working with Management in identifying trends and opportunities to enhance the pre-visit, registration and scheduling functions for patients/subjects and department staff.
Attending start up meetings to review and communicate registration and scheduling responsibilities of study team members.
Serving as a liaison to study teams and research subjects utilizing the research subject participant reimbursement program (PRC) managed by the Department.
Ensuring eligibility and compliance to PRC program SOPs in place.
Performing billing charge entry duties for the Department.
Under direction of the Charge Review Manager, entering billing charges into EPIC for programs set up for special charge entry sessions.
Resolving any registration, billing and charge entry issues with Manager; making recommendations for edits or process changes when necessary.
Serving as first point of contact via phone or email to resolve various questions and issues posed by study team members, striving to resolve questions or issue without Manager's involvement.
Handling a large volume of calls and directing them appropriately and efficiently.
Monitoring CTFM email inbox, resolving issues/questions when appropriate or distributing email to appropriate CTFM staff or inbox.
Following up with CTFM staff on resolution of issues.