Payment Reimbursement Analyst - Physician Billing
Children’s Hospital of Philadelphia
- Philadelphia, PA
- $74,250-94,660 per year
- Permanent
- Full-time
This role is responsible for analyzing outstanding accounts receivable balances that are not paid according to CHOP's payor contract terms and regulatory reimbursement information to ensure CHOP maximizes collection of payor reimbursement.The role will identify trends and root causes by reconciling expected reimbursement to the payment received from the payor. The role will work with the appropriate Revenue Cycle Operations Teams to remediate issues that are internal to CHOP. For external issues, the role will work with Third Party Payors and the CHOP Managed Care Team to achieve a resolution.The role will also serve as a resource and subject matter expert to other team members.What you will do
- Routinely perform Payor underpay/overpay review and analysis
- Routinely review Payor contract terms and reimbursement methodologies to guide analysis of Payor variances
- Produce customized payment variance reports and summarize findings; share information with senior leadership to assist with decision making
- Function as a liaison between Revenue Integrity, Managed Care Contracting, Revenue Analytics, and other team members from Revenue Cycle Operations
- Provide guidance, training, and knowledge transfer to Patient Financial Services, as well as other members of the Revenue Cycle Operations team
- Participate in ad hoc reporting, analysis or projects as required
- Associate's Degree Required
- Bachelor's Degree Preferred
- At least three (3) years experience in healthcare, contracting, financial analysis or related areas Required
- At least five (5) years experience in healthcare, contracting, financial analysis or related areas Preferred
- Knowledge of insurance contracts, billing regulations and medical terminology (Required proficiency)
- Knowledge of HCPCS/CPT/ICD-10 and revenue codes (Required proficiency)
- Familiarity with manipulating data sets. (Required proficiency)
- Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy. (Required proficiency)
- Must be detail oriented and have the ability to learn quickly and work independently (Required proficiency)
- This person should have strong problem solving skills. (Required proficiency)
- Strong interpersonal and communication skills with the ability to explain analyses. (Required proficiency)
- Preferred Technology Skills/Systems Experience: EPIC, Microsoft Office (Particularly Excel), Workday, Business Objects (Preferred proficiency)
- Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association - within 12 months - Preferred