Senior Collections Representative
Children's National Medical Center, Washington, District of Columbia, United States
Description
The person in this position will be responsible for monitoring and researching 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. The 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. The employee will monitor and report payer authorization delays and stall tactics as they occur, follow up with insurance carriers to facilitate timely and correct reimbursement for high balance cases, investigate reasons for non-payment and delays, perform root cause analysis of identified trends, write appeals to recover denied and underpaid claims, support the payer escalation process by ensuring high balance cases are prepared for outsourcing to an attorney, and gather documentation and summarize issues for the attorney.
Qualifications 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 leveling, authorization, eligibility and other functions to release a clean claim for billing.
Continuously monitor the pending report with CRM to resolve issues timely.
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; communicate deficiencies and resolutions that impact reimbursement.
Respond in a timely fashion to deviations from established 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, including senior management.
Assist in developing solutions, training & education to resolve issues and share data with staff and management.
Continuously improve design and performance of established reporting and tracking systems.
Appeal
Ensure all high-dollar denials & underpayments are appealed & followed up timely; maximize recovery of reduced reimbursement.
Manage large volumes of denials, denial amounts and various appeal deadlines to prioritize workload.
Process individual denials and ensure written appeals are clear, concise and within timely limits.
Collection Support
Check for payment posting and receive list of unpaid claims from the system; proactively follow up on submitted claims to determine payment status.
Collect information from carriers about documentation needed for payment.
Contact internal departments (Health Information Management, Clinic Operations) to provide documentation to carrier for claim payment; provide via fax, phone or mail 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 a record.
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 within identified parameters; refer to manager as appropriate.
Safety
Speak up when team members exhibit unsafe behavior or performance.
Continuously validate and verify information needed for decision making or documentation.
Stop in the face of uncertainty and take 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 to self-check behavior and performance.
Organizational Accountabilities Organizational Commitment/Identification
Anticipate and respond to customer needs; follow up until needs are met.
Teamwork/Communication
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others' ideas and opinions.
Performance Improvement/Problem-solving
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.
Cost Management/Financial Responsibility
Use resources efficiently.
Search for less costly ways of doing things.
Primary Location District of Columbia-Washington
Work Locations Remote Work Location
111 Michigan Avenue NW, Washington 20010
Job Accounting & Finance
Organization Finance
Position Status R (Regular) – FT - Full-Time
Shift Day
Work Schedule 40 hours per week
Job Posting Feb 23, 2026, 12:59:32 PM
Full-Time Salary Range 39832 – 66393.6
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Qualifications 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 leveling, authorization, eligibility and other functions to release a clean claim for billing.
Continuously monitor the pending report with CRM to resolve issues timely.
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; communicate deficiencies and resolutions that impact reimbursement.
Respond in a timely fashion to deviations from established 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, including senior management.
Assist in developing solutions, training & education to resolve issues and share data with staff and management.
Continuously improve design and performance of established reporting and tracking systems.
Appeal
Ensure all high-dollar denials & underpayments are appealed & followed up timely; maximize recovery of reduced reimbursement.
Manage large volumes of denials, denial amounts and various appeal deadlines to prioritize workload.
Process individual denials and ensure written appeals are clear, concise and within timely limits.
Collection Support
Check for payment posting and receive list of unpaid claims from the system; proactively follow up on submitted claims to determine payment status.
Collect information from carriers about documentation needed for payment.
Contact internal departments (Health Information Management, Clinic Operations) to provide documentation to carrier for claim payment; provide via fax, phone or mail 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 a record.
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 within identified parameters; refer to manager as appropriate.
Safety
Speak up when team members exhibit unsafe behavior or performance.
Continuously validate and verify information needed for decision making or documentation.
Stop in the face of uncertainty and take 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 to self-check behavior and performance.
Organizational Accountabilities Organizational Commitment/Identification
Anticipate and respond to customer needs; follow up until needs are met.
Teamwork/Communication
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others' ideas and opinions.
Performance Improvement/Problem-solving
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.
Cost Management/Financial Responsibility
Use resources efficiently.
Search for less costly ways of doing things.
Primary Location District of Columbia-Washington
Work Locations Remote Work Location
111 Michigan Avenue NW, Washington 20010
Job Accounting & Finance
Organization Finance
Position Status R (Regular) – FT - Full-Time
Shift Day
Work Schedule 40 hours per week
Job Posting Feb 23, 2026, 12:59:32 PM
Full-Time Salary Range 39832 – 66393.6
#J-18808-Ljbffr