Senior Collections Representative

Children's National Hospital

12d • $20 - $33

About The Position

The Senior Collections Representative monitors and researches in-house and discharged-not-final-billed cases to mitigate potential denials and ensure claims are clean before billing. The role works closely with Clinical Resource Management (CRM) to confirm the correct clinical level of care and ensure insurers receive clinical information needed for timely authorizations. It monitors and reports payer authorization delays and follows up with insurers to facilitate timely, accurate reimbursement, particularly for high-balance cases. The representative investigates nonpayment and delays, performs root-cause analysis, writes appeals to recover denied or underpaid claims, and prepares high-balance cases for possible attorney outsourcing by gathering documentation and summarizing issues.

The role reviews inpatient cases before billing, monitors pending cases with CRM, maintains the outpatient discharged-not-final-billed report, and updates diagnosis codes from PPM. It analyzes billing, collection, and denial issues, communicates deficiencies and resolutions, recommends process improvements, supports training and education, and improves reporting and tracking systems. It also manages denial appeals and deadlines, follows up on submitted and denied claims, obtains and supplies documentation requested by carriers, prioritizes higher-balance accounts, and may recommend adjustments or write-offs within established parameters.

The position promotes safety through accurate verification and communication, speaking up about unsafe behavior, pausing to resolve uncertainty, and carefully self-checking work. The listed salary range is $19.65–$32.75 per hour. The employer describes a comprehensive benefits package and a collaborative, mission-driven pediatric-care environment.

Requirements

• High school diploma or GED.
• At least 5 years of related patient accounting experience, especially denial mitigation, root-cause analysis, and level-of-care reconciliation.

Responsibilities

• Review inpatient cases before billing to verify leveling, authorization, eligibility, and other requirements for releasing a clean claim.
• Continuously monitor pending cases with CRM to ensure issues are resolved in a timely manner.
• Maintain the outpatient DNFB report, including updating diagnosis codes from PPM.
• Conduct root-cause analysis of issues that reduce reimbursement or slow the payment cycle; identify, track, trend, and report key issues and communicate deficiencies and resolutions.
• Respond promptly to deviations from established processes and standards.
• Analyze billing, collection, and denial processes and recommend process improvements based on findings.
• Interact with stakeholders at all levels, including senior management, and assist in developing solutions, training, and education for staff and management.
• Improve the design and performance of reporting and tracking systems.
• Ensure high-dollar denials and underpayments are appealed and followed up on promptly to maximize recovery.
• Manage denial volumes, amounts, and appeal deadlines to prioritize work and maximize reimbursement.
• Prepare clear, concise written appeals within applicable appeal deadlines.
• Check payment posting and unpaid-claim lists; proactively contact carriers by phone or web to determine payment status and required documentation.
• Contact internal departments, including Health Information Management and Clinic Operations, to obtain information and documentation needed to facilitate claim payment.
• Provide documentation to payers by fax, phone, or mail, such as operative reports.
• Track denied-claim appeals, determine their status, work with carriers toward payment, and resubmit claims when a payer has no record of them.
• Prioritize work to facilitate payment of higher-balance accounts.
• Follow up with a parent when an insurer has paid the parent and reimbursement is due, when applicable.
• Recommend billing adjustments and write-offs within established parameters and refer matters to a manager as appropriate.
• Monitor and report payer authorization delays and stall tactics; follow up with carriers to facilitate timely and correct reimbursement, especially for high-balance cases.
• Investigate and report reasons for nonpayment and delays; prepare high-balance cases for attorney outsourcing by gathering documentation and summarizing issues.
• Promote safety by speaking up about unsafe behavior, validating information, resolving uncertainty, communicating accurately and promptly, and self-checking work.

Benefits

• Comprehensive medical, prescription, infertility, and transgender health coverage.
• Paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• 401(k) plan.
• Healthcare and dependent-care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Tuition assistance.
• Fitness resources.
• Employee assistance program.
• Commuter benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED