Senior Hospital Billing Representative

Silver Spring, Maryland-Silver Spring
Sep 01, 2020
Oct 06, 2020
Full Time
The Senior Hospital Billing Representative will resolve clearinghouse and payer rejected claims and failed claims relating to coding, eligibility , system and charge errors in the host and claims systems. Will participate in inter-office teams to contribute to general account resolution. Will be well-versed in patient account review , problem identification and resolution in the host systems in accordance with HIP AA, CMS, Medicaid, commercial payer specific standards and CNMC billing policy and procedure. Will help with interruption of medical records and coding rules for hospital billing. Will work in a team environment toward the shared goal of clean claim filing within expected time frames. Will have shared responsibility to monitor the daily functions and testing of the claims processing system in accordance with CNMC policy and procedure to include system problem tracking and resolution, import and export balancing and documentation. Will record and maintain daily , monthly and year to year totals and year to year comparisons. Will documents and report problems and trends to Manager.


Minimum Education
High School Diploma or GED (Required)

Associates Degree /hospital billing trade certification or related experience (Required)

Minimum Work Experience
5 years - Hospital Billing and Claims Process for Medicaid, MCO, HMO and Commercial Payers (Required)

5 years - Hospital Billing and Claims Process with knowledge of Professional ICD and CPT coding and billing rules (Preferred)

Required Skills/Knowledge
Experience with hospital service billing and coding; insurance eligibility verification and registration.
Detail oriented with excellent organizational and communication skills both oral and written.
Fast paced - productivity driven with emphasis on quality.
Knowledgeable of Hospital Coding rules for CPT and ICD.
Expert computer skills including Excel, Word and electronic interchange in the healthcare environment.
Understanding of managed care contracts and insurance compliance

Functional Accountabilities

Daily Claims Process
1. Perform quality control of daily claims processing activity by tracking and documenting daily import results, Relay Health acknowledgement and exclusions, export and laser printed totals to ensure file balancing and problem resolution.
2. Work diligently with, IT , CA Support and electronic billing vendor to resolve system issues.
3. Research "claims not imported" and make necessary corrections to reprocess from Host.
4. Participate in system and data testing by performing import and export processing functions, problem solving and reporting as mandated by the test specifications.
5. Monitor daily system processes to ensure system functionality.

Daily Billing
1. Manage daily claim volumes to address claims within the expected time frames
2. Within identified parameters applies adjustments, transaction updates, charge corrections and removals based on department procedure and policy
3. Provide support as needed to team for billing and other projects.
4. Review patient account and apply corrections to dates of service affected by the changes

Registration Corrections
1. Follow department procedure apply registration corrections to internal systems for Outpatient accounts.
2. Follow department procedure communicate and correct errors for inpatient accounts both in-house and discharged.
3. Monitor, document and communicate department and user trends which result in registration errors.

Coding Corrections
1. Coordinate supporting documentation with claim data to problem solve coding errors
2. Communicate with provider, clinic manager , or Revenue Integrity to approve or recommend non-standard code corrections.
3. Following policy and procedure correct assigned failed and rejected claims related to CPT , ICD9 and ICD10 coding errors.
4. Monitor errors to identify trends by department or user. Document and report findings routinely .

Payer Contracts and Billing Requirements
1. Monitor changes related to NCCI edits, CMS and payer related changes and annual coding changes and communicates changes and updates.
2. Apply principles for assigned payers for managed care billing requirements.
3. Develop detailed understanding of state/federal assistance programs, e.g., Medicaid
4. Be aware and understand federal and state regulations surrounding billing.
5. Participate in payer webinars, in-service and internal business meetings related to registration and eligibility improvement, AAPC news and internal coding concerns/news

Organizational Accountabilities
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

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

Children's National Health System is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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