Job Information
The Children's Hospital of Philadelphia Authorization Denials Administrator - Utilization Management in Philadelphia, Pennsylvania
Reference #: 1008658 SHIFT:Day (United States of America)
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 Under the Direction of the Director/Manager, creates reviews and generates reports for the case management and admission departments. Identifies and tracks trends related to departmental metrics. Functions as the system administrator for the case management software systems. Must be able to meet deadlines, work on several projects at once, and understand all of the concepts involved in the work performed. Supports the operations of the Department and associated case management services and denials. Serves as a liaison between case management and the billing and finance department to resolve hospital claim issues
What you will do Denial Management Works to overturn denied days by: reviewing encounter in work queue. Review billing information in EPIC, contract reimbursement spreadsheets, payor's specific approval/level of care information, and case management system. Serves as a liaison between case management and the business office to resolve patient account denials Retro-review process - organizes and coordinates the process to document retro-approvals and communicates outcomes with the business office. a. Process includes identifying missing days in hospital encounter, assigns review to case manager, tracks completion of the work & dollars overturned, and notifies the business office when to reprocess the bill. Update and reconcile denial database Oversees the NJ Medicaid certification forms - follow-up on forms that have not been returned/signed by physicians, and then sends to the billing office. Oversees projects and works independently and responsibly as assigned. Reporting Creates Generates and Analyzes department operational reports and maintain dashboards. Systems Administrator Build and maintain case management system tables as needed. Front Line support for case managers - questions, workflows, system errors and interface with CHOP Service desk for escalation.
Education Qualifications High School Diploma / GED Required Bachelor's Degree Preferred
Experience Qualifications At least five (5) years of progressively responsible business office and billing experience Required Analytic and report building experience. Required
Skills and Abilities Proficient with Microsoft Word and Excel Knowledge of PowerPoint. Ability to work independently with minimal supervision. Ability to be proactive in following up on projects and tasks. Excellent phone etiquette. Ability to handle confidential materials. Ability to handle multiple tasks. Excellent organizational skills. Knowledge of medical terminology and protocol.
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 gainst COVID-19 and receive an annual influenza vaccine.
Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.
|
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.