Senior Collections Associate

Senior Collector

As a Senior Collector at Children's Hospital of Philadelphia (CHOP), you'll play a crucial role in ensuring timely and accurate reimbursement for inpatient, outpatient, and observation servicesdirectly supporting the hospital's mission to provide exceptional care to children and families.

You'll analyze denied claims, lead appeals, and verify patient coverage to optimize revenue while helping enhance processes that support both financial health and patient experience. Working closely with cross-functional teams across the revenue cycle, you'll gain a holistic understanding of the claim lifecycle and contribute to projects that strengthen our ability to fund world-class pediatric care. If you are detail-oriented, proactive, and passionate about contributing to CHOP's mission through your financial expertise, this is the opportunity for you.

The team is hybrid and you will work 4 days at home and once a week at the Cira Center @ 2929 Arch Street, Philadelphia. Core work hours are 8am-5pm, Monday-Friday.

What You Will Do

Claims Submission and Denial Resolution:

• Submits timely, accurate claims to insurance carriers according to insurance payor guidelines through established methods and procedures using current available technology.
• Resolve patient insurance balances by analyzing denials and using critical thinking skills and knowledge of payer requirements to determine the steps needed to obtain payment.
• Work in either No Pay No Response, Denial work queues, or both.
• Based on payer processes, utilize payer portals, paper/electronic remits and/or place calls to the payer to understand and resolve denials.
• Perform adjustments as needed.
• Place phone calls, sends email or written communication to families to resolve denials that require intervention from the guarantor.
• Files appeals on behalf of the patient to resolve denials. Reviews and acts on correspondence for assigned accounts.
• Gather Medical Records, using ROI, to assist in resolving denials as needed.

Account and Workflow Management:

• Ability to manage daily job functions along with special project work and prioritize level of importance on demand.
• Identifying third party payor response trending and escalation to management team as deemed necessary.
• Reviewing data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts.
• Prioritize assigned work based on department needs and direction from leadership team.
• Follow workflows to route accounts to other CHOP departments (Case Management, Medical Records, Credit Resolution, Billing, Abstraction, Clinical Teams, Coding etc.) to address denials.
• Advise supervisor of contractual issues as discovered.
• Works accounts holistically, building on the last intervention and not repeating tasks.
• Identifies patients with multiple denials and works from a guarantor level to resolve issues completely for a family.
• Completes projects as assigned for specific payers or specific types of accounts, ensuring deadlines are met.

Performance and Quality Metrics:

• Position requires adherence to production and quality metrics.
• Identifies trends in assigned work queues and reports to leadership.
• Meets established daily/weekly reasonable work expectation of productivity and quality requirements.

Communication and Collaboration:

• Excellent oral and written communication skills with strong analytical skills.
• Suggests ideas and solutions for performance and quality improvement and provides feedback to team leaders.
• Ability to communicate effectively and collaborate with teams across Patient Financial Services and other departments around operational efficiencies.
• Provide recommendations for corrective action to management team to ensure efficiency of the revenue cycle.
• Interfaces well with all levels of staff and management.

Training and Leadership:

• Provides training as assigned to new employees, as well as cross training.
• Demonstrates quality and effectiveness in work habits in every interaction with colleagues and leadership.

Compliance and Organizational Values:

• Responsible for full comprehension of CHOP revenue cycle work design including registration, billing, payment posting, account receivable follow-up, and compliance actions.
• Maintains all PHI in accordance with HIPPA, JACHO, third party contractual agreements along with CHOP policy and procedures.
• Demonstrates behaviors that are consistent with CHOP's organizational values of Integrity, Compassion, Accountability, Respect and Excellence (ICARE). Ensures work is performed, relationships are built, responsibility is assumed, and service delivered expresses the CHOP's values through action.
• Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
• Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations.

Other Duties:

• Other duties as assigned within the scope of the responsibilities.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least two (2) years experience in billing, payment posting, operations, or related role Required
• At least three (3) years experience in billing, payment posting, operations, or related role Preferred

Skills and Abilities

• HIPAA compliance standards (Required proficiency)
• Effective communication, interpersonal skills, analytical skills, and problem solving skills. (Required proficiency)
• Excellent organizational and time management skills. (Required proficiency)
• Detail and results oriented. (Required proficiency)
• High aptitude for math. (Required proficiency)
• Excellent writing and oral communication skills. (Required proficiency)
• Ability to work independently and prioritize work. (Required proficiency)
• Basic Computer skills (Required proficiency)
• High proficiency in Microsoft Excel. (Required proficiency)
• Demonstrated customer service skills, customer focus abilities and the ability to understand Children's Hospital of Philadelphia customer needs. (Required proficiency)
• Must maintain high-level knowledge of claim submission requirements. (Required proficiency)
• Ability to work cooperatively in a team environment. (Required proficiency)
• Demonstrated effective interpersonal, verbal, and written communication skills. (Required proficiency)
• Knowledge of Microsoft Office applications including Word, Excel. (Required proficiency)
• Must have 10-key by touch. (Required proficiency)
• Demonstrated experience with multiple computer applications. (Required proficiency)
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Required proficiency)
• Knowledge of third-party reimbursement and physician/hospital billing. (Preferred proficiency)
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Preferred proficiency)
• Experience with Epic systems (Preferred proficiency)

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.

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 for more information regarding CHOP's Compensation and Benefits.