Senior Collections Representative

3 weeks ago

Silver Spring, United States Children's National Medical Center Full time

The person in this position will be responsible to monitor and research cases that are in-house and on the discharged not final billed report to mitigate any potential denials and ensure that claims are clean before billing. Individual will work closely with Clinical Resource Management (CRM) to ensure cases reflect the correct clinical level of care and ensure clinical information is received by the insurance carrier for timely level of care authorizations by the payers. Monitor and report payer authorization delays and stall tactics as they occur . Follow-up with all insurance carriers to facilitate timely and

correct reimbursement for high balance cases. Investigate and report reasons for non-payment and delays. Perform root cause analysis of the various trends identified. Write appeals to recover denied and underpaid claims. Support payer escalation process by being able to ensure high balance cases are prepared for outsourcing to attorney . Gather documentation and summarize issues for attorney .

Minimum Education

High School Diploma or GED (Required)

Minimum Work Experience

5 years Related patient accounting experience required especially related to denial mitigation, root cause analysis and LOC reconciliation. (Required)

Functional Accountabilities

Pre-Billing

* Review inpatient cases before billing to ensure that leveling, authorization, eligibility and any other function to ensure a clean claim is released for billing.
* Continuously monitor the pending report with CRM to ensure issues are resolved in a timely manner.
* Maintain OP DNFB to include updating DX codes from PPM.

Analyze and Report

* Conduct root cause analysis of issues reducing reimbursement & slowing payment cycle; identify key issues and assist in tracking, trending and reporting; identify and clearly communicate deficiencies and resolutions of issues impacting reimbursement; respond in a timely fashion to any deviation from established and required processes and standards.
* Conduct analysis on a wide variety of issues related to billing, collections and denial processes; make process improvement recommendations based on findings; interact at all levels of CNMC to include senior management.
* Assist in development of solutions, training & education to resolve issues and share data with staff and management.
* Continuously work to improve the design and performance of the established reporting and tracking systems.

Appeal

* Ensure all high dollar denials & underpayments are appealed & followed up timely; ensure maximum recovery of reduced reimbursement.
* Manage large volumes of denials, denial amounts and various appeal deadlines to prioritize workload and maximize reimbursement.
* Process individual denials and ensure written appeals are clear, concise and within timely appeal limits.

Collection Support

* 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) for 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 payer 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; refer to manager as appropriate.

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

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment/Identification

* Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

* Demonstrate collaborative and respectful behavior
* Partner with all team members to achieve goals
* Receptive to others' ideas and opinions

Performance Improvement/Problem-solving

* Contribute to a positive work environment
* Demonstrate flexibility and willingness to change
* Identify opportunities to improve clinical and administrative processes
* Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

* Use resources efficiently
* Search for less costly ways of doing things

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

  • Housekeeper

    3 weeks ago

    Silver Spring, United States Sunrise Senior Living Full time

    Sunrise Senior Living - JobID: 210348 [Room Attendant / EVS Associate / Cleaning] As a Housekeeper at Sunrise, you'll: Perform general housekeeping duties in resident suites, public areas and support areas as assigned; Be responsible for collecting, cleaning and redistributing the community laundry; Assist Care Managers and Department Coordinators with...

  • Client Support Representative

    2 weeks ago

    Silver Spring, United States Aurora Ripple Enterprises Full time

    Aurora Ripple Enterprises is a growing, privately owned sales and marketing company in the area that serves over 5,000 customers regionally. We are currently seeking a collaborative and solution-oriented individual to join our client marketing and sales support team! Our Client Support Representative role is a full-time position. If you are a team player and...

  • Client Support Representative

    4 weeks ago

    Silver Spring, United States Aurora Ripple Enterprises Full time

    Aurora Ripple Enterprises is a growing, privately owned sales and marketing company in the area that serves over 5,000 customers regionally. We are currently seeking a collaborative and solution-oriented individual to join our client marketing and sales support team! Our Client Support Representative role is a full-time position.If you are a team player and...

  • Dietician

    4 hours ago

    Silver Spring, United States Sunrise Senior Living Full time

    Overview"It makes me feel good knowing that we make the residents’ lives better. We laugh with them, cry with them, sing and dance with them – we brighten their day. Working here is an unbelievable privilege and it will be something I carry with me for the rest of my life!"- Sunrise Team Member At Sunrise, our Dietitian is responsible for implementing...

  • Patient Service Representative

    5 days ago

    Silver Spring, United States RadNet Full time

    Responsibilities Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people with the commitment to a better healthcare experience. When you join us as a...

  • Patient Service Representative

    3 days ago

    Silver Spring, United States Community Radiology Associates Full time

    Job Description: Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people with the commitment to a better healthcare experience. When you join us as a...

  • Administrative Assistant

    3 days ago

    Silver Spring, United States Riderwood Village by Erickson Senior Living Full time

    **Location**: Riderwood Village by Erickson Senior Living Situated on 120 beautiful acres in Silver Spring, Maryland, Riderwood is the largest continuing care retirement community in the United States. We’re part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with...

  • Business Analyst, Senior

    4 days ago

    Silver Spring, United States Booz Allen Hamilton Full time

    Job Number: R0197370 Business Analyst, Senior Key Role: Elicit, analyze, document, and validate the business needs of stakeholders, customers or end users. Collaborate with stakeholders to determine project scope and vision. Develop or contribute to solutions to a variety of problems of moderate scope and complexity. Works independently with some guidance...

  • Senior Cashier

    5 days ago

    Silver Spring, United States Trinity Health Corporation Full time

    Employment Type: Full time Shift: Day Shift Description: Job Title: Senior Cashier Employment Type: Full-time Shift: Day (SUMMARY) Position Highlights: * Competitive salary * Benefits - Medical, Dental & Vision, PTO, Free Parking, Metro Access, Tuition Reimbursement, 403(b) * Quality of Life: Flexible work schedules * Advancement: Career growth...

  • Full Time Housekeeper Night Shift

    5 hours ago

    Silver Spring, United States Riderwood Village by Erickson Senior Living Full time

    **Location**: Riderwood Village by Erickson Senior Living Situated on 120 beautiful acres in Silver Spring, Maryland, Riderwood is the largest continuing care retirement community in the United States. We’re part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with...

  • Associate Executive Director

    4 hours ago

    Silver Spring, United States Riderwood Village by Erickson Senior Living Full time

    Location:Riderwood Village by Erickson Senior LivingSituated on 120 beautiful acres in Silver Spring, Maryland, Riderwood is the largest continuing care retirement community in the United States. We’re part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with campuses...

  • Senior Business Analyst

    2 weeks ago

    Silver Spring, United States Metric5 Full time

    Location: Washington, DC; Reston, VA; Silver Spring, MD (Remote Flexibility) Description: Metric5 is looking for a motivated Senior Business Analyst with strong Project Management skills to join an agile program supporting our US Treasury client. As a Senior Business Analyst, you will be responsible for collaborating with the product owner, SMEs, and...

  • Director of Nursing

    2 days ago

    Silver Spring, United States Sunrise Senior Living Full time

    OverviewThe Director of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning, organizing and leading overall operations of nursing services in accordance with federal, state, and local standards and Sunrise Senior Living policies to promote the highest degree of quality care and...

  • Senior Cashier

    4 days ago

    Silver Spring, United States Trinity Health Full time

    Employment Type: Full timeShift: Day Shift Description: Job Title: Senior Cashier Employment Type: Full-time Shift: Day (SUMMARY) Position Highlights: Competitive salary Benefits - Medical, Dental & Vision, PTO, Free Parking, Metro Access, Tuition Reimbursement, 403(b) Quality of Life: Flexible work schedules Advancement: Career growth opportunities...

  • Director of Nursing

    2 days ago

    Silver Spring, United States Sunrise Senior Living Full time

    OverviewThe Resident Care Director (RCD) serves as the nursing clinical leader for the community and is responsible to lead and manage the health and wellness along with coordination of care and services to residents within the community. Responsible for oversight and implementation of all Care programs, regulatory compliance, recruiting, and performance...

  • Director of Nursing

    5 days ago

    Silver Spring, United States Sunrise Senior Living Full time

    OverviewThe Resident Care Director (RCD) serves as the nursing clinical leader for the community and is responsible to lead and manage the health and wellness along with coordination of care and services to residents within the community. Responsible for oversight and implementation of all Care programs, regulatory compliance, recruiting, and performance...

  • Call Center Representative

    4 weeks ago

    Silver Spring, United States Advantia Health Full time

    OB-Gyn Associates of Advantia is seeking a full-time bilingual Call Center Representative. This role will be responsible for greeting, registering and scheduling patients while working closely with practice providers and staff to ensure an exceptional patient experience. Job Responsibilities: * Serves patients by greeting and helping them on the telephone,...

  • Dental Patient Representative

    4 days ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone. Our vision is a healthy and empowered community for generations to come. Position Summary:The Dental Patient Representative uses their experience and...

  • Senior Games Technician

    5 days ago

    Silver Spring, United States Dave & Buster Full time

    Job Description: Dave & Buster's is different from everywhere else. No two days are ever the same. Time will fly by serving hundreds of people with flexible schedules you can accommodate school or other jobs. Plus, your co-workers are awesome! Dave & Buster's offers an attractive benefits package for many positions, including medical, dental, vision, 401K,...

  • Call Center Representative

    3 weeks ago

    Silver Spring, United States Advantia Health Full time

    OB-Gyn Associates of Advantia is seeking a full-time bilingual Call Center Representative. This role will be responsible for greeting, registering and scheduling patients while working closely with practice providers and staff to ensure an exceptional patient experience. Job Responsibilities: Serves patients by greeting and helping them on the telephone,...