Hospital Billing Representative - (Job Number: 230000NM)

Children's National Hospital; Washington (District of Columbia); On-site; USD 45,000 - 70,000; Full time

Job summary

Children's National Hospital is looking for a Hospital Billing Specialist to manage hospital claims, ensuring accuracy and compliance with regulations. The role requires strong analytical skills and experience in hospital billing. Candidates should possess at least a High School Diploma or equivalent, and relevant experience in the health services field.

Qualifications

• 2 years of experience in hospital billing or related education is required.
• Knowledge of CPT/ICD coding and hospital billing regulations.
• Hospital Coding and/or Billing Certification is required.

Responsibilities

• Ensure accuracy of hospital claims and compliance with regulations.
• Monitor claims and resolve billing issues.
• Track billing trends and support documentation.

Skills

Analytical problem solver

Detail oriented

Good communication skills

Knowledge of hospital service billing

Education

High School Diploma or GED

Associate's Degree

Tools

Excel

Word

Job description

The Hospital Billing Specialist will be responsible to ensure hospital claims are complete, accurate and billed within the expected time frame according to internal billing policy, Federal and State regulations and Managed Care contract guidelines. Will be well-versed in HIP AA standards, NCCI coding and billing regulations for hospital service claims to include hospital, specialty and primary care based services. Will develop a detailed understanding of assigned managed care contractor and payor requirements. Will track and report billing trends with assigned carriers.!*!Minimum Education
High School Diploma or GED (Required)
Associate's Degree Associates Degree / Healthcare Billing Vocational Training (Preferred)

Minimum Work Experience
2 years Hospital billing or related education (Required)
5 years Hospital billing, collections and coding (Preferred)

Required Skills/Knowledge
Analytical problem solver, detail oriented, efficient, and productivity driven.
Ability to process large volumes on a daily basis.
Computer Skills.
Accurate and Expediant Typing.
Web Search. Excel, Word.
Good communication skills both verbal and written.
Understanding of managed care contracts and insurance compliance.
Detail oriented with excellent organizational skills.
Fast paced - productivity driven with emphasis on quality.
Knowledge of hospital service billing / CPT/ ICD coding.

Required Licenses and Certifications
Hospital Coding and/or Billing Certification (Required)

Functional Accountabilities
Queue Management

• Monitor Claims Outstanding Report daily using various sorts to manage daily claim volumes and timelines according to policy.

• Monitor claim errors by Form and report trends, new incidents, duplications, incorrect payer mix and unusual volumes.

Productivity

• Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.

• Follow-up and resolve claims in Held status daily .

• Bill secondary claims no less than twice a week - Maintain age less than 5 days from import.

• 150 to 200 claims addressed per day contingent on assignment.

Quality

• Coordinate supporting documents to ensure validity for services billed.

• Audit claim details for standard claim data prior to submission to ensure accuracy and complete edit satisfaction.

• Follow written procedure, payer policy , guidelines and edit instruction completely

• Stay abreast of payer updates on at least a quarterly basis and shares changes with Leadership and Team.

Claim Corrections and Billing

• Research coding errors using CPT and ICD guidelines, Craneware and NCCI tools, Medical Records and Account Systems. Following procedure pursue authorization for code corrections.

• Apply data corrections to claim and/or host systems performing transaction updates/same claim or charge corrections/new claim as outlined in procedures.

• Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections (Held claim) or not billed (Archive/Del). Document the: (1) Problem, (2) Research, (2) Findings, (3) Action Taken, (4) FU plan

• Coordinate submission of supporting documentation, e.g., treatment plans, operative reports, EOB.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification

• Anticipate and responds to customer needs; follows 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

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

HSC Bunker Hill Peds Ctr (L063)
1731 Bunker Hill Road NE
Washington , 20017

About the company

Children's National Hospital is a nationally ranked, freestanding, 323-bed, pediatric acute care children's hospital located in Washington DC.

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