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Reference #: 911862600Location:LOCCIRA-Cira CentreReq ID:206071Shift: DaysEmployment Status:Regular - Full TimeAbout UsWe're seeking breakthrough makers! Children's Hospital of Philadelphia was built on the belief that we can change lives. Today, in every role throughout our hospital, research institute and care network, the 22,000 members of our workforce are finding new ways - big and small - to make a difference for the patients and families we serve.If you are ready to challenge yourself, be inspired and grow - no matter what your role - you just may be the kind of breakthrough maker who will thrive at CHOP.CHOP is proud to share that we are ranked No. 1 on Forbes' 2022 list of America's Best Large Employers!Job SummaryThis role is responsible for AR follow-up of assigned payers. Assist supervisor in reference to distribution and reviewing of special projects and weekly/daily assignments. Must set a positive example for team members and act as the initial resource for problem solving. Must be able to handle potential stressful situations as well as multiple tasks at one time. Must be a positive role model for staff members and work with them to promote teamwork and cooperation. Must work within their team to continually improve accuracy and efficiency.Job ResponsibilitiesAccounts Receivable Follow-up with assigned payers.Maintains Accounts Receivable goals of assigned payers including AR days and % of AR greater than 90 daysEnsure all edit and rejection reports Paper or electronic are completed and appropriate action was taken.Inform Supervisor of any discrepancies related to billing and/or insurance companies on a weekly or immediate basis when a crisis may arise.Informs management of any payer trendsResponsible for special projects for assigned payersResponsible for ensuring complete reviews of claims, identifies and researches any problems and forwards to appropriate insurance company.Job Responsibilities (Continued)Responsible for completing review of electronic claim rejections for assigned payersResponsible for reviewing claims for rejection, pending or accepted status of assigned payersRejected claims are to be reviewed by the A/R representative for appropriate follow-up.Responsible for ensuring appropriate action is completed within the same business day and returned.Any issues with claims pending, or remitted are to be reported to the Supervisor immediatelyResponsible for review of appropriate action for completed refunds/credit balances.Responsible for reviewing and assuring appropriate action of a completed refund to an insurance company or responsible party.Responsible to enter approved refunds/offsets with the appropriate action code within one (1) business day of receipt. When this is complete forward to receptionist or designee to enter the detail information in the appropriate offset or refund spreadsheet log for tracking purposes.Continue to maintain expected measures and standards of an Account RepresentativeInform Supervisor of all outstanding and unresolved issues related to billing or insurance companies on a weekly basis, or immediately if necessary.Job Responsibilities (Continued)Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was rejected or question why a claim was not processed.Does all necessary follow up to obtain payment of claims; including but not limited to, claim status and interventionReviews entire accounts to ensure claims were billed properly, payments were applied correctly and all necessary adjustments were made 100% of the time.Gathers all necessary documentation needed in order to have claims paid.Informs supervisor of any problems that arise 100% of the time.Records all pertinent comments and follows up accordingly, always following the guidelines set forth by management.Documents each contact in accordance with department guidelinesResponsible for denial management for assigned payors; this will include review, follow up an
