Accounts Receivable Collection Representative, Physician Billing

Children's Hospital of Philadelphia - Philadelphia, PA

Full-time

Philadelphia, PA

10,001+ employees

Hospitals

About the position

The Accounts Receivable Collection Representative at Children's Hospital of Philadelphia (CHOP) is responsible for the timely resolution of patient accounts under the supervision of the Collection Manager. This role involves making collection calls, managing payor relations, and overseeing the financial management of accounts receivable to ensure efficient billing processes and resolution of claims.

Responsibilities

• Review remittance advices (RAs) and explanation of benefits (EOBs) of assigned payors/accounts.
• Review accuracy of RAs/EOBs on a weekly basis; contact payors to resolve inappropriate denials/rejections.
• Work with other CHOP departments (ie: Case Management, Medical Records, Credit and Billing) to appeal legitimate denials.
• Advise supervisor of contractual problems on a weekly basis.
• Resolve patient accounts billed to insurance payers or directly to the guarantor.
• Conduct at least 60 daily telephone calls or access Payer website to inquire on status of claims.
• Send and receive payor correspondence via mail and/or fax on a daily basis.
• Utilize account work queues to expedite resolution of outstanding accounts.
• Complete 90% of work list (or other mutually agreed percentage) on a weekly basis.
• Review account work queues for thoroughness and applicability to workload with supervisor on a monthly basis.
• Maintain complete, accurate and up-to-date account history for each account.
• Review appropriateness of account balances (ie: allowances, late charges, duplicate charges, insurance and patient balance, etc) on a monthly basis.
• Enter comments in account notes system for all patient accounting activity.
• Escalate individual problem accounts to Supervisor or Manager.
• Identify payer trends for denials.
• Prepare for Payer meetings.
• Maintain orderly filing system.
• Coordinate medical record requests and audit requests of payors.
• Submit requests for medical records within two working days.
• Refer bills and audits to internal auditor on a weekly basis archiving on a weekly basis.
• Perform other duties as assigned.

Requirements

• High School Diploma / GED Required
• Bachelor's Degree Preferred
• Healthcare experience and/or claims processing, billing, collections or customer service experience preferred
• 1 year of physician/professional or hospital accounts receivable collections experience preferred
• Ability to follow through with any patient financial problems until they are adequately resolved
• Good working knowledge of third party insurance and public assistance programs
• Good working knowledge of hospital computer information systems (ie: SMS IDX or EPIC)
• Excellent organizational, written and verbal communication skills.