Billing Associate

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 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 The Billing analyst plays a key role in supporting the Primary Care, Urgent Care, and Behavioral Health (PUB) Billing Team and will report to the PUB Billing Supervisor. They will be responsible for claim submissions to healthcare insurance carriers for Hospital, Physician Practice, or Home Care services through established methods and procedures using current available technology. Supports the CHOP mission with efficient and effective revenue cycle management. How This Role Supports the Organization This role supports organizational goals by ensuring billing submissions and payer requirements are aligned with CHOP’s contractual obligations and established standards. Ideal Candidate The ideal candidate has front‑end billing experience and is familiar with Epic billing edits. Common Career Path: Billing Specialist, Supervisor Work Flexibility & Schedule: This role offers a flexible schedule with an in‑office expectation once per week, every Wednesday, at the Cira Center (11th Floor), 2929 Arch Street, Philadelphia, PA. Core working hours are Monday–Friday, 8:00 a.m. to 5:00 p.m., with flexibility to start as early as 7:00 a.m. to support operational needs and work‑life balance. What you will do Submits timely, accurate claims to insurance carriers according to insurance payor guidelines through established methods and procedures using current available technology. Promptly and accurately resolves claim edits. Collaborates with CHOP departments and physician practices to resolve outstanding claims not meeting payer claim edits for reimbursement processing. Ensures all claims are accepted by payers for payment processing. Utilize electronic/clearinghouse billing software to process claims. Utilizes various tools including websites, payor documents and internal denial analytics reports to perform duties. Reviewing data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts. Understanding of the revenue cycle process and third-party health plan and government payer requirements for compliant, accurate claims processing. Reviewing data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts. Ability to work the internet for access to insurance payer portals. 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. Ability to research, resolve and accurately document. Suggests ideas and solutions for performance and quality improvement and provides feedback to team leaders. Responsible for full comprehension of CHOP revenue cycle work design including registration, billing, payment posting, account receivable follow-up, and compliance actions. Demonstrates quality and effectiveness in work habits in every interaction with colleagues and leadership. Provides training as assigned to new employees, as well as cross training. Interfaces well with all levels of staff and management. Meets established daily/weekly reasonable work expectation of productivity and quality requirements. Maintains all PHI in accordance with HIPAA, 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. 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. 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 as assigned within scope of responsibilities. Education Qualifications High School Diploma / GED - Required Associate's Degree - Preferred Experience Qualifications At least one (1) year experience in billing, payment posting, operations, or related role Required At least two (2) years experience in billing, payment posting, operations, or related role Preferred Experience with Epic systems 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) 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) 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: $24.87 - $31.09 Hourly 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. Children's Hospital of Philadelphia (CHOP) is the nation's first hospital devoted exclusively to the care of children. Since our start in 1855, CHOP has been the birthplace for countless breakthroughs and dramatic firsts in pediatric medicine. Built on a foundation of delivering safe, high-quality, family-centered care, the Hospital has fostered medical discoveries and innovations that have improved pediatric healthcare and saved countless children’s lives. Today, families facing complex conditions come to CHOP from all over the world, and our compassionate care and innovation has repeatedly earned us a spot on the U.S. News & World Report's Honor Roll of the nation's best children's hospitals.