Senior Collections Representative

Patient Accounting Specialist

Kids Are Our Everything.

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 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

Benefits That Support You:

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more.

Why Join Us:

• Nationally Recognized Excellence Consistently ranked among the Top 10 Children's Hospitals in the nation by U.S. News & World Report.
• Leading Pediatric Care One of the largest and most comprehensive children's hospitals in the country, offering nationally ranked specialties and cutting-edge treatments.
• Innovation & Research A premier academic medical center with a strong commitment to pediatric research, education, and advancing the future of child health.
• Mission-Driven Culture Dedicated to providing family-centered care while fostering a collaborative, supportive environment for clinical teams.