Collections Representative

Kids Are Our Everything.

Department

10121 Patient Cash Application

Pay Range

$18.54 - $30.89

Join Children's National as a Collections Representative and play a key role in strengthening the revenue cycle by resolving complex claim denials, following up with payers, and helping ensure timely and accurate reimbursement for the care we provide. In this role, you will use your knowledge of medical billing, insurance requirements, denial management, appeals, and account resolution to research issues, identify root causes, and support process improvements that reduce delays and improve outcomes. We are looking for a detail-oriented, analytical, and collaborative professional who communicates effectively with payers and internal teams, takes ownership of challenging accounts, and is motivated by meaningful work that supports children, families, and the communities we serve.

Follow-up with insurance carriers, include Medicaid/Medicare, to facilitate appropriate reimbursement for Children's hospital and physician services. Investigate reasons for non-payment and collect information and provide necessary documentation to insurance carriers. Write letters of appeal to support payment of denied claims. Document activities and contacts in systems. Develop detailed understanding of assigned managed care contractor and payor requirements. Track and report payment trends with assigned carriers.

Minimum Work Experience

1 year Experience in hospital/physicians collections (Required)

Required Skills/Knowledge

Knowledge of billing with a third party payors

CPT/HCPS codes ICD 9/10 Microsoft 2010 Intermediate Excel

Ability to multitask

Develop knowledge of internal billing systems to research denials, appeals and follow-up action.

Excellent Customer Service Skills.

Functional Accountabilities

Appeal Process for Denied Claims

• Receive denial correspondence from insurance companies via mail or payment posting process indicating that claims are not being paid, may be electronic or paper format; evaluate type of denial using codes and prioritize work based on size of claim and likelihood of payment.
• Proactively follow-up on submitted claims to determine payment status through telephone or web contact in a timely manner.
• Research reason for denial and collect more information and documentation: review system records to identify source of denial; contact Clinic Operations staff, Utilization Management department and Health Information Management department to collect necessary information and documents, e.g., referrals, authorizations for appeal.
• May recommend adjustments and write-offs to bill within identified parameters; refer to manager as appropriate; with required documents, write timely appeals for payment.
• Manage large volume of denials to maximize reimbursement.

Follow-Up Submitted Claims

• Check for payment posting and receive list of unpaid claims from system.
• Proactively follow-up on submitted claims to determine payment status through telephone or web contact in a timely manner; collect information from carriers about what specific documentation is needed to pay claim; contact internal departments (Health Information Management, Clinic Operations) to information and documentation to carrier to facilitate claim payment; provide documentation via fax, phone or mail to payer, e.g., operative reports.
• Track appeals of denied claims to determine status and work with carrier for payment; Resubmit claim if payor does not have record of claim.
• Prioritize work to facilitate payment of higher account balances.
• May follow-up with parent if insurance has paid parent to receive reimbursement.
• May recommend adjustments and write-offs to bill within identified parameters; refers to manager as appropriate; Document actions in system including contact with payors, appeals sent, research findings, write-offs, documentation sent etc.

Tracking T rends

• Identify and report trends in denied and appealed claims to manager and work collaboratively to identify appeal and follow-up strategy inresponse to trends.

Safety

• Speak up when team members appear to exhibit unsafe behavior or performance
• Continuously validate and verify information needed for decision making or documentation
• Stop in the face of uncertainty and takes time to resolve the situation
• Demonstrate accurate, clear and timely verbal and written communication
• Actively promote safety for patients, families, visitors and co-workers
• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

The disclosed salary range includes the minimum and maximum rates within which Children's National believes an individual's base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children's National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual's combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children's National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The "Know Your Rights" poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a "drug-free" work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.