1-3 years of experience
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Employment Type:
Full time
Job Category:
Health Care Provider
Health Care & Medicine
Credit & Collections Representative II
(This job is no longer available)
Children's National Health System | Silver Spring, MD
Grad Date

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Job Description


 Minimum Education
High School Diploma or Equivalent. 

Minimum Work Experience
1 Year(s)

Specific Requirements and Preferences
At least 1-3 years experience in hospital/physicians collections. Knowledge of billing with a third party payors.

Required Skills/Knowledge
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
  1. 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.
  2. Proactively follow-up on submitted claims to determine payment status through telephone or web contact in a timely manner.
  3. 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.
  4. May recommend adjustments and write-offs to bill within identified parameters; refer to manager as appropriate; with required documents, write timely appeals for payment.
  5. Manage large volume of denials to maximize reimbursement.
Follow-Up Submitted Claims
  1. Check for payment posting and receive list of unpaid claims from system.
  2. 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.
  3. Track appeals of denied claims to determine status and work with carrier for payment; Resubmit claim if payor does not have record of claim.
  4. Prioritize work to facilitate payment of higher account balances.
  5. May follow-up with parent if insurance has paid parent to receive reimbursement.
  6. 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 Trends
  1. Identify and report trends in denied and appealed claims to manager and work collaboratively to identify appeal and follow-up strategy in response to trends.
  1. Speak up when team members appear to exhibit unsafe behavior or performance
  2. Continuously validate and verify information needed for decision making or documentation
  3. Stop in the face of uncertainty and takes time to resolve the situation
  4. Demonstrate accurate, clear and timely verbal and written communication
  5. Actively promote safety for patients, families, visitors and co-workers
  6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Organizational Accountabilities (Staff)

Program Knowledge
  1. Understand managed care contracting requirements and apply principles for assigned payors.
  2. As assigned, develop detailed understanding of state/federal assistance programs, e.g., Medicaid.
  3. Understand federal and state regulations surrounding payment denials and appeals as it applies to assigned payors.
Organizational Commitment/Identification
  1. Partner in the mission and upholds the core principles of the organization
  2. Committed to diversity and recognizes value of cultural ethnic differences
  3. Demonstrate personal and professional integrity
  4. Maintain confidentiality at all times
Customer Service
  1. Anticipate and responds to customer needs; follows up until needs are met
  1. Demonstrate collaborative and respectful behavior
  2. Partner with all team members to achieve goals
  3. Receptive to others’ ideas and opinions
Performance Improvement/Problem-solving
  1. Contribute to a positive work environment
  2. Demonstrate flexibility and willingness to change
  3. Identify opportunities to improve clinical and administrative processes
  4. Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  1. Use resources efficiently
  2. Search for less costly ways of doing things

About Children's National Health System

Childrens National Medical Center is the only exclusive provider of pediatric care in the metropolitan Washington area and is the only freestanding childrens hospital between Philadelphia, Pittsburgh, Norfolk, and Atlanta. Serving the nations children for more than 130 years, Childrens National is a proven leader in the development and application of innovative new treatments for childhood illness and injury.

Childrens National is proudly ranked consistently among the best pediatric hospitals in America by US News & World Report.

Our Culture

Children's mission is to be preeminent in providing pediatric health care services that enhance the health and well-being of children regionally, nationally and internationally. Through leadership and innovation, Children's creates solutions to pediatric healthcare problems. Children's excels in Care, Advocacy, Research, and Education to meet the unique needs of children, adolescents and their families. Children's leadership realizes that our employees are the heart of our medical center and the soul of our mission. One of our greatest assets is the diversity of our workforce, which adds to the richness of our culture. Teamwork, dedication, and professionalism are essential values and characteristics that make our employees unique.

Childrens internationally recognized team of pediatric healthcare professionals care for more than 360,000 patients each year who come from throughout the region, nation and world. Our employees share a sense of pride and commitment to the patients and families we serve. We aspire to provide patients and their families with the highest quality of care and service in a family-centered environment. In essence, we are a team of "Great People Providing Great Care."

Nursing Students

As a nursing student, you might already be craving hands-on experience at a highly respected hospital. You may be thinking about where or with which population you want to work after graduation.

At Childrens, a world-class teaching hospital and internationally-recognized leader in pediatric health, we invite nursing students at all stages of learning to explore the real world of working in a hospital setting and experience first-hand the challenges and rewards of this career.

Internship Program

The internship program provides the novice nurse with the knowledge base and skill set needed to transition to competence in clinical nursing practice. While providing the needed skills to meet the organization goals and mission, the program provides nurses with the leadership skills to work collaboratively within a multidisciplinary team. The program bridges the gap between undergraduate education and real-life professional nursing practice, delivering state-of-the art pediatric care.

The program is offered to new graduate nurses from an accredited nursing program with a passion for children. All new graduates, with less than one-year acute care experience, are eligible to participate in the program after obtaining licensure.