Account Representative- CHCA Billing

Breakthrough Makers At Children's Hospital of Philadelphia

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 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.

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

Experience Qualifications

Skills and Abilities

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, professionals working onsite-at any CHOP location, for any portion of time-must be vaccinated for COVID-19. Learn more.

CHOP also requires employees who work in patient care buildings to receive an annual influenza vaccine. Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

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