Children's National Hospital · 1 day ago
Senior Collections Representative
United States
Full-time
Remote
Senior Level
$40K/yr - $66K/yr
5+ years expChildren's National Hospital is seeking a Senior Collections Representative to oversee the monitoring and research of billing cases to mitigate potential denials and ensure clean claims. The role involves close collaboration with Clinical Resource Management to manage payer authorizations and facilitate timely reimbursements for high balance cases.
AssociationChild CareHealth CareNon Profit
Responsibilities
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
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
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
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
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
Anticipate and responds to customer needs; follows up until needs are met
Demonstrate collaborative and respectful behavior
Partner with all team members to achieve goals
Receptive to others’ ideas and opinions
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
Use resources efficiently
Search for less costly ways of doing things
Qualification
Required
High School Diploma or GED (Required)
5 years Related patient accounting experience required especially related to denial mitigation, root cause analysis and LOC reconciliation. (Required)
Company
Children's National Hospital
Children’s National Hospital, based in Washington, D.C., was established in 1870 to help every child grow up stronger.
Founded in 1870Washington, District of Columbia, USA
5001-10000 employees
H1B Sponsorship
Children's National Hospital has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (82)
2024 (55)
2023 (92)
2022 (59)
2021 (41)
2020 (51)
Funding
Current Stage
Late StageTotal Funding
$19.4MKey Investors
Gilbert Family FoundationAdvanced Research Projects Agency for HealthUnited Health Foundation
2025-10-09Grant· $8M
2024-10-23Grant· $8M
2021-11-09Grant· $3.4M
Leadership Team
Kurt Newman
President and CEO
Michelle Riley-Brown, MHA, FACHE
President and CEO
Recent News
BioWorld Financial Watch
2025-06-07
Company data provided by crunchbase