Senior Collections Representative

111 Michigan Avenue Northwest Washington, DC 20010 Kids Are Our Everything. Department 10116 Patient Accounting Pay Range $19.65 - $32.75 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…

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