Payment Reimbursement Analyst - Physician Billing

SHIFT:

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 does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview
This role is responsible for analyzing outstanding accounts receivable balances that are not paid according to CHOP's payor contract terms and regulatory reimbursement information to ensure CHOP maximizes collection of payor reimbursement.

The role will identify trends and root causes by reconciling expected reimbursement to the payment received from the payor. The role will work with the appropriate Revenue Cycle Operations Teams to remediate issues that are internal to CHOP. For external issues, the role will work with Third Party Payors and the CHOP Managed Care Team to achieve a resolution.

The role will also serve as a resource and subject matter expert to other team members.

What you will do

• Routinely perform Payor underpay/overpay review and analysis
• Routinely review Payor contract terms and reimbursement methodologies to guide analysis of Payor variances
• Produce customized payment variance reports and summarize findings; share information with senior leadership to assist with decision making
• Function as a liaison between Revenue Integrity, Managed Care Contracting, Revenue Analytics, and other team members from Revenue Cycle Operations
• Provide guidance, training, and knowledge transfer to Patient Financial Services, as well as other members of the Revenue Cycle Operations team
• Participate in ad hoc reporting, analysis or projects as required

Education Qualifications

• Associate's Degree Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least three (3) years experience in healthcare, contracting, financial analysis or related areas Required
• At least five (5) years experience in healthcare, contracting, financial analysis or related areas Preferred

Skills and Abilities

• Knowledge of insurance contracts, billing regulations and medical terminology (Required proficiency)
• Knowledge of HCPCS/CPT/ICD-10 and revenue codes (Required proficiency)
• Familiarity with manipulating data sets. (Required proficiency)
• Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy. (Required proficiency)
• Must be detail oriented and have the ability to learn quickly and work independently (Required proficiency)
• This person should have strong problem solving skills. (Required proficiency)
• Strong interpersonal and communication skills with the ability to explain analyses. (Required proficiency)
• Preferred Technology Skills/Systems Experience: EPIC, Microsoft Office (Particularly Excel), Workday, Business Objects (Preferred proficiency)

Licenses and Certifications

• Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association - within 12 months - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

EEO / VEVRAA Federal Contractor | Tobacco Statement

SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

-------------------

At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.