Billing Associate- Physician Billing

Billing Associate

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. We are focused on attracting, cultivating, and retaining talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children. We strongly encourage candidates of all races, colors, ethnicities, religions, perspectives, sexes, backgrounds, and lived experiences to apply.

A Brief Overview

Billing Associate

The Billing Associate is responsible for claim submissions to healthcare insurance carriers for Hospital, Physician Practice, or Home Care services through established methods and procedures using current available technology. Supports the CHOP mission with efficient and effective revenue cycle management.

What You Will Do

• Submits timely, accurate claims to insurance carriers according to insurance payor guidelines through established methods and procedures using current available technology.
• Promptly and accurately resolves claim edits.
• Collaborates with CHOP departments and physician practices to resolve outstanding claims not meeting payer claim edits for reimbursement processing.
• Ensures all claims are accepted by payers for payment processing.
• Utilizes electronic / clearinghouse billing software to process claims.
• Utilizes various tools including websites, payor documents and internal denial analytics reports to perform duties.
• Reviews data sets CPT-codes, IDC-10 codes, HCPCS codes, coordination of benefits, registration discrepancies, third party payer rules, and payer contracts.
• Understanding of the revenue cycle process and third-party health plan and government payer requirements for compliant, accurate claims processing.
• Ability to work the internet for access to insurance payer portals.
• Ability to manage daily job functions along with special project work and prioritize level of importance on demand.
• Identifying third party payor response trending and escalation to management team as deemed necessary.
• Ability to research, resolve and accurately document.
• 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.
• Demonstrates quality and effectiveness in work habits in every interaction with colleagues and leadership.
• Provides training as assigned to new employees, as well as cross training.
• 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).
• Ability to communicate effectively and collaborate with teams across Patient Financial Services and other departments around operational efficiencies.
• Provide recommendations for corrective action to management team to ensure efficiency of the revenue cycle.
• Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
• Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations.
• Other duties as assigned within scope of responsibilities.

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.

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.