Account Rep - CHCA Billing

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers
Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.
At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.
CHOP’s Commitment to Diversity, Equity, and Inclusion
CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.
We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview
The primary responsibility of the account representative is to ensure all accounts are processed in an accurate and efficient manner. This is in accordance with the established CHCA billing office policies and procedures. Account Representative must be able to adapt to the constant changes within the healthcare environment; stay abreast of all healthcare reform implications to operations and revenue.

What you will do

• Based on specific assignment, the AR Representative is responsible to perform the following:
• Claims
• Identifies problems in Claims Edit work queue or Claim Logic Lists and resubmits claims.
• Works claim edit work queue on a daily basis and resubmit claims through the Epic billing system
• Works actions and edits through Claim Logic on a daily basis
• Paper claims processing daily including proper documentation
• Communicates all claims/data problems that cannot be handled to the Lead A/R Representative within one (1) day of identifying the problem.
• Identifies and researches all incomplete or inaccurate information on claims, demonstrate proper handling and escalation as needed.
• Notify the AR Lead when a claim backlog in Claim Logic exits from prior month outstanding greater than 3 days post month-end.
• AR Debit Follow-up
• Utilizes the Epic Billing System to review and monitor accounts through the Follow-Up work queues
• Work the Denied, Low pay and No Response accounts within the Follow-Up work queue while maintaining established productivity requirements.
• Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was rejected or questions why a claim was not processed.
• Performs all follow- up necessary to obtain payment/resolution of claims.
• Reviews entire account to ensure claims were billed properly, payments were applied correctly and all necessary adjustments were made.
• Gathers all necessary documentation needed in order to have claims reprocessed/adjudicated
• Informs Lead of any problems that arise that require escalation within 2 days of identification.
• Documents all actions taken within the EPIC account notes section
• AR Credit Follow-up
• Responsible for review of credit balance receivables within the Credit work queues and must take appropriate action for resolution
• Document within Epic all justification for processing refunds to insurance based on process grid
• Process all system adjustment reversals timely
• Identify issues and communicate concerns to the Lead within 1 day of identifying the problem.
• All AR Reps
• Maintain file on all departmental policies and procedures/training documents.
• Document all inactive time periods and make available upon management request.

Education Qualifications

• High School Diploma / GED Required

Experience Qualifications

• At least two (2) years Billing experience. Required

Skills and Abilities

• Experience working with EPIC preferred
• Clear oral and written communication.
• Professional telephone etiquette.
• Able to interact with physicians, patients and co-workers in a professional and helpful manner.
• Use of billing computer and PC skills.
• Problem solving and decision making skills.
• Use of an adding machine.
• Able to work independently.

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a conditio