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Seeking Breakthrough Makers
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's Commitment to Diversity, Equity, and Inclusion
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 diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.
We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview
This role will work in collaboration with clinical staff to standardize and streamline the verification and authorization process for patient referrals. This would include all possible visits, tests, procedures, and treatment plans - for both new patients and second opinion referrals. Use of the patients' record to both access and document information which supports authorization, therefore, insuring a systematical approach to sharing critical information. Network with other precertification/insurance employees across CHOP's billing entities to stay abreast of and share recent changes, updates, and processes. Provide complete information to the Single Case Agreement Team on initial request in an effort to facilitate an agreed to systematical process for non-par insurance plans. Maintain and develop clear lines of communication with insurance representatives from multiple insurance companies who can provide precertification/authorization guidelines unique to their company. This role will develop the role so as to be a resource/mentor and leader to other CHOP staff members who perform similar work. Provide guidance and share knowledge with staff in regards to insurance authorization/intake/registration. Must be able to effectively manage work across department and work independently with minimal supervision and participate in administrative decisions. Strong communication skills, attention to detail and a high level of organization are critical qualities.

What you will do

Responsible for verifying and authorizing the insurance of all new patients referred as well obtaining emergency authorization for scans/tests for all existing patients.
Obtain authorization for all non par scans or procedures for all patients
Communicates directly with disease specialists and clinical staff regarding status of authorization and the need for clinical documentation
Verify coverage & benefit information via electronic eligibility or by contacting the payer
Document all relevant information into EPIC
Partners with Single Case Agreement Department to facilitate authorizations
Establishes process with Revenue Cycle to insure collection of payment, especially for non par insurance companies
Partners with Revenue Cycle and billing to collect any backlogged revenue
Educates families and clinical team regarding insurance coverage plans.
Communicates with family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party.
Respond to emails, answer calls, provide explanation of covered and non-covered services
Contacts appropriate clinical staff in timely manner with all information that requires follow-up.
Develop and maintain systems to streamline communication with staff on all aspects of insurance
Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs and refer to FHCC when appropriate.
Training/Education Responsibilities
Provides onsite training to scheduling, intake and registration staff with regard to insurance matters
Educates providers, intake coordinators and families on insurance issues
Assists in creating brochure which provides insurance information for families
Creates templates with correct CPT Codes for specific services for Single Case Agreement
Registration Responsibilities
Create and/or update patient record by verifying demographic, insurance information, or proper study identification in the registration system
Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payer plan entries for research and standard-of-care visits
Verify coverage through Navinet/Passport, etc. and pull appropriate referrals.
Coordinate & communicate insurance issues with appropriate personnel (e.g. schedulers, Pre-cert dept, out-of -area dept, Self-Pay group, Single Case Agreement Team and PCP's staff when required.
Educate and inform family of outstanding financial obligations if appropriate. Provide documentation in Guarantor's Notes in Epic.
Electronically collect or facilitate payment of outstanding balances

Education Qualifications

High School Diploma / GED Required
Associate's Degree Preferred
Bachelor's Degree Preferred

Experience Qualifications

At least five (5) years related healthcare registration, billing and/or reimbursement experience Required
Previous experience in complex clinical setting that required coordination of multiple services Required
Background in Medical Insurance Required
Resource scheduling experience (e.g. ancillary testing) Preferred

Skills and Abilities

Advanced insurance authorization and registration techniques
Ability to provide training to staff in complexity of Insurance Authorization
High level of interpersonal skills with excellent customer service and responsiveness
Background in medical terminology
Strong Customer Service experience required
Ability to multi-task and prioritize is crucial to success in the position
Individual must be highly organized and dependable
Ability to prioritize and work on several projects at once while maintaining communication with all invested parties.
Strong communication skills
Ability to work with stressful situations
Ability to function efficiently and professionally with minimum of supervision.
Ability to quickly learn new procedures.
Strong computer skills.
Ability to juggle multiple insurance issues.
Strong customer service skills
Ability to display compassion and empathy
Website Insurance Training (Navinet, WebMD, Passport)
EPIC training & testing (Prelude/Cadence).
Registration Essentials

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, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.
Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.
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