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Home Care PFS Accts Rec Rep

Philadelphia, PA, US, 19104

Job Type: 

Req ID: 26399

Shift: Days

Employment Status: AF - Active - Regular - Full Time 

Job Summary

Responsible for collection follow up on all Home Infusion and Home Health claims.  Initiating and receiving collection calls, and working on patient accounts as directed by Reimbursement Manager. Perform all necessary generation and claim submissions required for reimbursement and make any necessary contractual adjustments to patient accounts.

Job Responsibilities

1. Reviews explanation of benefits received from insurance carriers according to alpha split.
• Reviews EOB for payment accuracy and resubmits
claims to carrier if accurate payment was not
received.
• Reviews EOB for denials and submits appeal for
claims that were denied inappropriately.
• Performs all necessary contractual adjustments
that may occur during review of patient account.

• Initiates collection calls to Insurance
carriers to resolve any payment or denial
discrepancies.
• Provides insurance carrier with all necessary
documentation requested for reimbursement.
• Provides therapy assigned precert coordinator with
authorization requests when dictated by payer.
• Documents all outcomes of collection follow
up activity in assigned collection follow up
spreadsheet and updates SCS with collection
activities.


2. Collaborates with Reimbursement Manager on payer
specific claims projects.
• Performs necessary claims generation for payer
specific projects.
• Reviews claims for contractual accuracy, and
audits claims according to payer specific
guidelins.
• Performs all necessary contractual adjustments
that may occur during review of patient claims.
• Make any corrections or send any
additional information that is
requested by the payer.
• Documents all outcomes of collection follow
up activity in assigned collection follow up
spreadsheet and updates SCS with collection
activity.

 

3. Provides Reimbursement Manager with updates and
feedback related to payer issues.
• Provides claim specific issues related to
collection activity to Reimbursement Manager.
• Prepares payer issues in a detailed and
organized approach utilizing an excel
spreadsheet to provide A/R specifics.
• Documents patient specific issues in claim
notes.

 


4. Performs patient eligibility checks, make necessary
changes to system, and communicate changes to
designated therapy specific percert coordinator.
• Performs necessary system changes to insurance
field upon discovery of change.
• Communicates changes to assigned therapy precert
coordinator.
• Communicates changes to primary billing representative.

 

5. Provide coverage assistance to Reimbursement *
area and Home Care department as directed.
• Provide coverage for phone operator
as directed by Reimbursement Manager.
• Perform other duties and responsibilities upon
request of the Reimbursement Manager.

Job Responsibilities (Continued)

Job Responsibilities (Continued)

Required Licenses, Certifications, Registrations

None

Required Education and Experience

•     High School graduate.

•     One (1) year experience with computers.

•     Two (2) years experience in health care billing.

Preferred Education, Experience & Cert/Lic

Additional Technical Requirements

  • Previous billing/reimbursement experience.
  • Strong organizational skills.
  • Strong verbal and communication skills.
  • Basic application and computer skills.
  • Strong data entry skills

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 

Email:TalentAcquisition@email.chop.edu

 

 

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