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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

The Revenue Integrity Supervisor will report to the Revenue Integrity Manager and is responsible for supervising all aspects of work by the CDM Process Manager and CDM Analysts. The Supervisor will support the content, integrity, and maintenance of the facility charge description master, facility pharmacy file and the facility supply charges.

The Supervisor will also manage the integrity and maintenance of the hospital owned physician practice fee schedules and Children's Hospital Home Care charge master.

The Supervisor role is responsible for oversight and communication of identified trends, root cause analysis, and reconciling expected reimbursement to the payment received from the payor as it relates to non-covered charges and CDM codes and modifiers. 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 support coordination between the CHOP Managed Care Team and Third-Party Payors to facilitate resolution.

What you will do

• Supervise the staff's routine performance of CDM Maintenance, CDM coding and related denials.
• Create and drive change related to non-allowed charges and the impact to lost reimbursement
• Ensure charges are valid based on routine billing expectations and/or specific payer feedback.
• Establish and provide guidance, training, and knowledge transfer to identified staff, as well as other members of Revenue Cycle Operations
• Initiate and oversee creation of policies and reports; produce formalized CDM and Audit findings to executive leadership monthly; and ensure timely and appropriate information is shared with Revenue Integrity leadership to assist with decision making
• Oversee communication of CDM/CFF/FSC maintenance activities to clinical departments and DTS staff to ensure requested changes are implemented (including changes that affect charge capture, charge reconciliation and claim processing).
• Directly supervise identified staff, develop goals, manage staff responsibilities and conducts performance reviews.
• Participate in cross-departmental meetings and committees.
• Assists staff with development of effective methods to address and resolve identified charge issues (CDM, CFF, FSC), and audit issues.
• Ensures that staff participates in educational development programs aligned with Revenue Cycle Operations.
• Remains knowledgeable of hospital CDM, pharmacy file, physician fee schedules and payor reimbursement methodologies.
• Works with other departments to ensure that staff have systems and appropriate access to support third party audit resolutions.
• Routinely review Payor denials to guide analysis of issues directly related to CDM, CFF, FSC.
• Function as a liaison between Payment Integrity, Revenue Analytics, Financial Clearance, HIM and PFS; also work with Compliance and Internal Audit as needed.
• Participate in ad hoc reporting, analysis or projects as required
• Collaborates with the RIS Auditors on identifying any possible trends related to CDM/CFF/FSC issues, payer denial and/or audit findings

Education Qualifications

• Bachelor's Degree Required
• Master's Degree Preferred

Experience Qualifications

• At least five (5) years Healthcare billing and Revenue Cycle environment Required
• At least three (3) years Supervisory experience Preferred

Skills and Abilities

• Strong working knowledge of revenue cycle processes Required
• Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy Required
• Knowledge of insurance contracts, billing regulations and medical terminology Required
• Strong organizational and multi-tasking skills to apply toward high-priority assignments to meet established deadlines Required
• Strong problem-solving skills with the ability to work independently towards specific goals and objectives and provide recommendations for improvement Required
• Excellent interpersonal & communication skills, with the ability to explain analyses, and demonstrate organizational and leadership abilities Required
• Technology Skills/Systems Experience: EPIC, Microsoft Office (Excel, Word, PPT) Required
• Knowledge of healthcare revenue cycle functions, and billing and collection processes specific to the charge master. Pharmacy file, physician fee schedules Required
• Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claims forms Required
• Identifies data and analytic challenges including data integrity, appropriateness of data sample, context, and consistency between sources. Fully leverages power of analytic tools. Required
• Experience supporting RI initiatives specific to implementation, and/or major process improvement and redesign. Required
• Plans effectively yet is fluid based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener Required

Licenses and Certifications

• Certified Revenue Cycle Representative (CRCR) Healthcare Financial Management Association within 12 months Preferred
• Certified Outpatient Coder (CPC-H) Certified Outpatient Coder (CPC-H) American Academy of Professional Coders (AAPC) Preferred
• or Certified Professional Coder (CPC) Certified Professional Coder (CPC-H) American Academy of Professional Coders (AAPC) Preferred

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.

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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