Patient Financial Services Associate II

SHIFT:

Seeking Breakthrough Makers

Childrens Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20000 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 careand your career.


CHOP does not discriminate on the basis of race color sex national origin religion or any other legally protected categories in any employment training or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.


A Brief Overview

Make an Impact Where Finance Meets Care
In this role youll play a critical part in strengthening CHOPs financial health while directly supporting exceptional patient care. Youll analyze denied claims lead appeal efforts and verify patient coverage to ensure accurate reimbursementhelping optimize revenue and improve processes across the revenue cycle. A key focus of the role includes reviewing Behavioral Health claims ensuring services are reimbursed appropriately and care delivery is fully supported.

Youll collaborate with cross-functional partners across finance clinical operations coding and revenue cycle teams gaining end-to-end exposure to the claims lifecycle. Your work will directly contribute to CHOPs ability to fund and deliver world-class pediatric care.

This role also invests in your growth: youll receive a complimentary Healthcare Financial Management Association (HFMA) membership providing access to nationally recognized training expert-led learning and industry certifications to advance your career.

Why This Role Is Exciting

High Visibility High Impact

Serve as a trusted financial partner supporting Nursing and operational leadershipfrom Unit Leaders to the Senior Vice President and Chief Nursing Officeron decisions that influence reimbursement and financial performance. Youll gain exposure to payer contract structures and strategies that maximize reimbursement.

Strategic Collaboration

Work closely with clinical operational coding and finance leaders to drive alignment improve outcomes and strengthen payer relationships.

Mission-Driven Work

Your expertise will directly support CHOPs mission to deliver exceptional care to children and familiesmaking a meaningful difference every day.

Growth & Development

CHOP is deeply invested in its people offering leadership development professional learning opportunities and long-term career advancement.

Community & Purpose

Participate in enterprise-wide volunteer opportunities and patient-focused initiatives that allow you to contribute beyond your day-to-day work.

What You Bring

• Financial & Analytical Expertise: Experience in financial planning analytics budgeting labor productivity or reimbursement within a hospital or healthcare setting; exposure to clinical operations is a plus.
• Improvement Mindset: A passion for operational excellence data-driven decision-making and continuous improvement.
• Collaborative Service-Oriented Approach: Ability to partner effectively with diverse stakeholders and deliver solutions that balance financial and operational needs.
• Strong Values: A commitment to integrity quality teamwork and meaningful organizational impact.

Work Environment & Flexibility

• Hybrid Schedule: Work remotely four days per week with one onsite day at the Cira Centre (2929 Arch Street Philadelphia).
• Remote-Friendly Hours: MondayFriday 8:00 a.m.5:00 p.m. supporting work-life balance.
• Purposeful Onsite Time: Periodic in-person collaboration to strengthen relationships plan strategically and support operational needs.
  

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.
• Resolve patient insurance balances by analyzing denials and using critical thinking skills and knowledge of payer requirements to determine the steps needed to obtain payment. Work in either No Pay No Response Denial work queues or both.
• Based on payer processes utilize payer portals paper/electronic remits and/or place calls to the payer to understand and resolve denials.
• Perform adjustments as needed.
• 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.
• Reviewing data sets CPT-codes IDC-10 codes HCPCS codes coordination of benefits registration discrepancies third party payer rules and payer contracts.
• Prioritize assigned work based on department needs and direction from leadership team.
• Follow workflows to route accounts to other CHOP departments (Case Management Medical Records Credit Resolution Billing Abstraction Clinical Teams Coding etc.) to address denials.
• Advise supervisor of contractual issues as discovered.
• Place phone calls sends email or written communication to families to resolve denials that require intervention from the guarantor.
• Document each account thoroughly explaining action taken on the account and completing note template provided.
• Gather Medical Records using ROI to assist in resolving denials as needed.
• Files appeals on behalf of the patient to resolve denials. Reviews and acts on correspondence for assigned accounts.
• Position requires adherence to production and quality metrics.
• Identifies trends in assigned work queues and reports to leadership.
• Works accounts holistically building on the last intervention and not repeating tasks.
• Identifies patients with multiple denials and works from a guarantor level to resolve issues completely for a family.
• Completes projects as assigned for specific payers or specific types of accounts ensuring deadlines are met.
• Excellent oral and written communication skills with strong analytical skills.
• 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 CHOPs organizational values of Integrity Compassion Accountability Respect and Excellence (ICARE). Ensures work is performed relationships are built responsibility is assumed and service delivered expresses the CHOPs values through action.
• 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 the scope of the responsibilities.

Education Qualifications

• High School Diploma / GED - Required
• Bachelors Degree - Preferred

Experience Qualifications

• At least two (2) years experience in billing payment posting operations or related role - Required
• At least three (3) years experience in billing payment posting operations or related role - Preferred

Skills and Abilities

• HIPAA compliance standards (Required proficiency)
• Effective communication interpersonal skills analytical skills and problem solving skills. (Required proficiency)
• Excellent organizational and time management skills. (Required proficiency)
• Detail and results oriented. (Required proficiency)
• High aptitude for math. (Required proficiency)
• Excellent writing and oral communication skills. (Required proficiency)
• Ability to work independently and prioritize work. (Required proficiency)
• Basic Computer skills (Required proficiency)
• High proficiency in Microsoft Excel. (Required proficiency)
• Demonstrated customer service skills customer focus abilities and the ability to understand Childrens Hospital of Philadelphia customer needs. (Required proficiency)
• Must maintain high-level knowledge of claim submission requirements. (Required proficiency)
• Ability to work cooperatively in a team environment. (Required proficiency)
• Demonstrated effective interpersonal verbal and written communication skills. (Required proficiency)
• Knowledge of Microsoft Office applications including Word Excel. (Required proficiency)
• Must have 10-key by touch. (Required proficiency)
• Demonstrated experience with multiple computer applications. (Required proficiency)
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Required proficiency)
• Knowledge of third-party reimbursement and physician/hospital billing. (Preferred proficiency)
• Experience in using commonly used electronic health records and healthcare revenue cycle financial management systems. (Preferred proficiency)
• Experience with Epic systems (Preferred proficiency)

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 receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If youre working part-time your pay will be adjusted accordingly.

At CHOP we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOPs Compensation and Benefits.