![Children's National Medical Center](https://media.trabajo.org/img/noimg.jpg)
Collections Representative
1 month ago
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 Education
High School Diploma or GED (Required)
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
Organizational Accountabilities
Program Knowledge
* Understand managed care contracting requirements and apply principles for assigned payors.
* As assigned, develop detailed understanding of state/federal assistance programs, e.g., Medicaid.
* Understand federal and state regulations surrounding payment denials and appeals as it applies to assigned payors.
Organizational Commitment/Identification
* Partner in the mission and upholds the core principles of the organization
* Committed to diversity and recognizes value of cultural ethnic differences
* Demonstrate personal and professional integrity
* Maintain confidentiality at all times
Customer Service
* 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
-
Senior Collections Representative
1 month ago
Silver Spring, United States Children's National Medical Center Full timeThe 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...
-
Senior Collections Representative
2 weeks ago
Silver Spring, United States Children's National Medical Center Full timeThe 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...
-
Senior Collections Representative
2 weeks ago
Silver Spring, United States Children's National Health System Full timeThe 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...
-
Senior Collections Representative
3 days ago
Silver Spring, United States Children's National Health System Full timeThe 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...
-
Client Support Representative
1 month ago
Silver Spring, United States Aurora Ripple Enterprises Full timeAurora 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
1 month ago
Silver Spring, United States Aurora Ripple Enterprises Full timeAurora 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...
-
Senior Patient Representative
4 days ago
Silver Spring, United States Community Clinic Full timePosition Summary: CCI Health Services is seeking a Senior Patient Representative to act as the point of contact by greeting patients and visitors in person and over the phone and directing them to the appropriate Health Center personnel. The Senior Patient Representative will assist in team leading, training, and assisting Patient Representatives in...
-
Senior Patient Representative
2 days ago
Silver Spring, United States Community Clinic Full timePosition Summary: CCI Health Services is seeking a Senior Patient Representative to act as the point of contact by greeting patients and visitors in person and over the phone and directing them to the appropriate Health Center personnel. The Senior Patient Representative will assist in team leading, training, and assisting Patient Representatives in assuring...
-
Patient Service Representative
3 weeks ago
Silver Spring, United States RadNet Full timeResponsibilities 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
1 week ago
Silver Spring, United States RadNet Full timeJob DescriptionJob DescriptionResponsibilitiesArtificial 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...
-
Patient Service Representative
3 weeks ago
Silver Spring, United States Community Radiology Associates Full timeJob 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...
-
Patient Service Representative
1 week ago
Silver Spring, United States Community Radiology Associates Full timeJob 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...
-
Senior Patient Representative
6 days ago
Silver Spring, United States Community Clinic Inc. Full timeJob DescriptionJob DescriptionPosition Summary:CCI Health Services is seeking a Senior Patient Representative to act as the point of contact by greeting patients and visitors in person and over the phone and directing them to the appropriate Health Center personnel. The Senior Patient Representative will assist in team leading, training, and assisting...
-
Senior Patient Representative
4 days ago
Silver Spring, United States Community Clinic Inc. Full timeJob DescriptionJob DescriptionPosition Summary:CCI Health Services is seeking a Senior Patient Representative to act as the point of contact by greeting patients and visitors in person and over the phone and directing them to the appropriate Health Center personnel. The Senior Patient Representative will assist in team leading, training, and assisting...
-
Senior Patient Representative
5 days ago
Silver Spring, United States Community Clinic Full timePosition Summary: CCI Health Services is seeking a Senior Patient Representative to act as the point of contact by greeting patients and visitors in person and over the phone and directing them to the appropriate Health Center personnel. The Senior Patient Representative will assist in team leading, training, and assisting Patient Representatives in assuring...
-
Call Center Representative
1 month ago
Silver Spring, United States Advantia Health Full timeOB-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,...
-
Call Center Representative
2 weeks ago
Silver Spring, United States Advantia Health Full timeOB-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
3 weeks ago
Silver Spring, United States Community Clinic Inc. Full timeJob 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...
-
Call Center Representative
1 month ago
Silver Spring, United States Advantia Health Full timeOB-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,...
-
Call Center Representative Bilingual
4 days ago
Silver Spring, United States CareerBuilder Full timeOB-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,...