Accts Receivable Spec - RACH

Philadelphia, PA, US, 19104

Job Type: 

Req ID: 26411

Shift: Days

Employment Status: AF - Active - Regular - Full Time 

Job Summary

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 Responsibilities

  1. Accounts Receivable Follow-up with assigned payers.
  • Maintains Accounts Receivable goals of assigned payers including AR days and % of AR greater than 90 days
  • Ensure 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 trends
  • Responsible for special projects for assigned payers
  • Responsible for ensuring complete reviews of claims, identifies and researches any problems and forwards to appropriate insurance company.
  1. Responsible for completing review of electronic claim rejections for assigned payers
  • Responsible for reviewing claims for rejection, pending or accepted status of assigned payers
  • Rejected 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 immediately
  1. Responsible 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 Representative
  • Inform Supervisor of all outstanding and unresolved issues related to billing or insurance companies on a weekly basis, or immediately if necessary.
  1. 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 intervention
  • Reviews 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 guidelines
  • Responsible for denial management for assigned payors; this will include review, follow up and escalation to management as required. Responsible for preparing, submitting and follow up of appeals for assigned payors.

Job Responsibilities (Continued)

Job Responsibilities (Continued)

Required Licenses, Certifications, Registrations


Required Education and Experience

  • High School diploma or equivalency.
  • Minimum of four years medical billing experience required.
  • Knowledge of third party payors.

Preferred Education, Experience & Cert/Lic

Additional Technical Requirements

  • Thorough knowledge of insurance billing requirements for all Third Party payers.
  • Clear oral and written communication.
  • Professional telephone etiquette.
  • Able to interact with physicians, patients and co-workers in a professional and helpful manner.
  • Use of billing computer and PC skills.
  • Problem solving and decision making skills.
  • Use of an adding machine.
  • Able to work independently
  • Good with basic math

All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.

Children's Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children's Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).

Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.

VEVRAA Federal Contractor/Seeking priority referrals for protected veterans.  Please contact our hiring official with any referrals or questions.

CHOP Careers Contact 

Talent Acquisition

2716 South Street, 6th Floor

Philadelphia, PA 19146 

Phone: 866-820-9288




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