Patient Account Resolution Specialist Responsible for timely resolution of patient accounts. Assigned duties include researching account balances and following up with collection calls to insurers and parents. Reviewing claims with no response. Reviewing denied claims or underpaid claims and resolving the denial and filing appeals, as necessary. Ensuring all information pertaining to collection activity is fully and accurately documented in the patient accounting system. Works to identify payment and denial trends for timely resolution. Works to identify internal and external causes of denials for timely resolution. Ability to work independently or as a member of a project team. This position could be assigned to hospital, professional or home care claims. Supports the CHOP mission with efficient and effective revenue cycle management.
Job Responsibilities:
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.
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.
Place phone calls, sends email or written communication to families to resolve denials that require intervention from the guarantor.
Document each account thoroughly, explaining action taken on the account and completing note template provided.
Gather Medical Records, using ROI, to assist in resolving denials as needed.
Files appeals on behalf of the patient to resolve denials. Reviews and acts on correspondence for assigned accounts.
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.
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.
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 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.
Skills
Required Skills & Experience:
At least two (2) years of experience in billing, payment posting, operations, or related role.
HIPAA compliance standards.
Effective communication, interpersonal skills, analytical skills, and problem solving skills.
Excellent organizational and time management skills.
Detail and results oriented.
High aptitude for math.
Excellent writing and oral communication skills.
Ability to work independently and prioritize work.
Basic Computer skills.
High proficiency in Microsoft Excel.
Demonstrated customer service skills, customer focus abilities and the ability to understand Children's Hospital of Philadelphia customer needs.
Must maintain high-level knowledge of claim submission requirements.
Ability to work cooperatively in a team environment.
Demonstrated effective interpersonal, verbal, and written communication skills.
Knowledge of Microsoft Office applications including Word, Excel.
Must have 10-key by touch.
Demonstrated experience with multiple computer applications.
Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems.
Preferred Skills & Experience:
At least three (3) years of experience in billing, payment posting, operations, or related role.
Knowledge of third-party reimbursement and physician/hospital billing.
Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems.
Experience with Epic systems.
Education
Required Education:
High School Diploma or GED.Preferred Education: Bachelor's Degree.
Required Certifications & Licensure:
- N/APreferred Certifications & Licensure:
- N/ARequired Education:
- High School Diploma or GED.Preferred Education:
- Bachelor's Degree.
- Required Certifications & Licensure:
- At least two (2) years of experience in billing, payment posting, operations, or related role.
- Certified Medical Coder Required.
Preferred Qualifications:
Experience in Accounts Receivable Experience in Medical BillingEEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
