Description

Accounts Receivable Billing and Denial Specialist

Are you excited about a new opportunity? Do you have a passion for working in Finance for non-profits? Are you mission-driven to help with processing accounts receivable claims? Well, look no further! At Community of Hope, we have worked diligently to improve health and end family homelessness to make Washington, DC, more equitable. We believe everyone in DC should have access to good healthcare, a stable income, and home, and hope! If you are ready to make a positive difference in the community, this position is for you!

At COH, we strive for: Caring for Families. Improving Lives. Leading Change

Our Approach and Values:

We care for families by providing direct services with a focus on prevention, healing, and wellness.

We improve lives by building on families’ strengths, honoring their choices, and taking a whole-family, multi-generational approach.

We lead and advocate for system change to address the effects of historical and current racial inequities on health outcomes and housing opportunities.

We embrace the diversity of our community, welcome all voices and perspectives, and treat everyone with respect, compassion, and integrity.

We strive for excellence in all that we do, implement evidence-based practices, measure our outcomes, and use this knowledge to continuously strengthen our work.

Position Summary: The Accounts Receivable Billing and Denial Specialist is accountable directly to the Billing Manager. This position is responsible for following up on outstanding claims in a timely manner according to the assigned inventory and follow-up guidelines. Utilizes and applies industry knowledge to resolve aged accounts receivable by working various account types and payers. This is a full-time position.

Highlighted Duties and Responsibilities:

• Monitors, identifies and reports aged inventory trends to Billing Manager weekly. Identify billing errors and denial reason codes in order to correct claim for future payments. If it involves the patient and/or guarantor make contact by phone and/or letter within 24-48 hours from issue being identified 
• Responsible for aged inventory (70-89 days for claims with 90 days for timely filing, 160-179 days for claims with 180 days timely filing and 240-364 days with claims with 365 days for timely filing) for the included claim’s date of service. Decrease the volume of aged claims by 5% month over month and assist the department by increasing cash by $50,000-$100,000 a month. Ensures claims do not fall into Timely Filing for adjustments.
• Place denial issues on master log to provide feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission daily. Create a resolution portion of the log to state how the error or denial should be corrected
• Communicate daily via insurance company’s resources such as website (portal), telephone, Customer Service and EDI departments including Change Healthcare if needed. Obtain documentation needed to support guidelines according to services completed at a Federal Qualified Health Center level
• If the insurance portal is not clear, call insurance companies daily and as needed, to determine when payments will be made and determine if any additional information is required to process denied claims. Notates practice management software (eCW) with findings.
• Updates patient account demographic information in ECW as needed
• Works a minimum of 50-60 claims daily in eCW by payer trends. Documents actions taken on each claim in practice management software (eCW) stating the following: who was contacted, what was found, and how it was corrected
• Review the Denial Report (including ERA DENIAL and INSURANCE REJECTION status codes) bi-monthly, analyze the report for new denials and trends. Monitor the report to be sure that 50% of the report has been corrected by the department. Analyze if the corrected denials are being paid or denials multiple times
• Write and submit professional appeals letters based on review of medical records and in accordance with Medicare, Medicaid and third-party guidelines and timeline. 
• Research and resolve payer denials related to pre-authorizations, eligibility, registration and billing resulting in denials for aged inventory. Escalate issues to Billing Manager after third attempt of efforts taken to resolve independently
• Follows up on corrected claims submitted after denials with insurance companies within 30 days of submission
• Conduct a bi-weekly meeting with the Billing and Follow up team to present the information found in the Bi-Monthly Denials report. A professional presentation will be created by the Account Receivable Billing and Denial Specialist to provide number of denials, reason codes and how to resolve the denial. The presentation will also include why aged claims were not processed by the payer on the original claim
• Completes other denial and project duties as assigned by supervisor

Requirements

 Minimum Qualifications:

• High School diploma required. Some college studies or associate degree preferred. 
• Experience with Medicare and DC Medicaid is strongly required/preferred.
• Will need to have the ability to take initiative when needed to share trends with leadership and move forward with hard problematic claims independently
• Minimum 2 years required and 4 preferred experience in physician, dental and behavioral health business office environment, specifically in collection and billing
• Maintains confidentiality in all matters that include Patient Health Information and employee data.
• Team player, highly organized and able to meet strict timely deadlines. Ability to prioritize and simultaneously manage all daily tasks
• Ability to work in a fast-paced environment
• Superior knowledge of computers including MS Office, Practice Management Systems (eClinicalWorks) payer’s website navigation and contract management.
• Analytical skills to assure that tasks are completed effectively and efficiently
• Able to perform basic and mathematical calculations, works credits on accounts and able to reconcile data
• In relation to remote work versus on-site expectations, this position is classified as the following: Remote: A majority of the position may be able to work remotely, but employees will be required to report to the office a minimum of twice per month. Please note that remote work designations are subject to change or fluctuate at any point in time and the supervisor may require in person learning for a specific amount of time after hire.

At COH, we understand the toll that the Covid-19 pandemic has taken on the workforce, which is why we prioritize the following well-being and work-life balance-centered benefits:

• Remote work opportunities are available for many of our roles, promoting a culture of work-life balance.
• 8-hour workdays, which include a paid lunch
• 11.5 paid company holidays, 1 personal floating holiday, 15 days of paid vacation (increases to 20 after 3 years of service), and 12 days of paid sick leave on an annual basis
• Annual performance-based raises, up to 5% of your annual pay
• National Health Service Corps (NHSC) and DC Health Professional Loan Repayment Program (DCHPLRP) participants
• Tuition reimbursement, loan repayment for clinicians, licensing reimbursement, and continuing education unit funds for licensed staff
• Many opportunities for internal promotions and transfers across the agency as we continue to grow; we average 30 promotions each year
• Ongoing internal leadership training for supervisors
• Diversity, equity, and inclusion training and initiatives for all staff
• Ongoing well-being activities, culture compact activities, and trauma-informed care initiatives
• Medical/Dental/Vision Plans through CareFirst BlueCross Blue Shield
• Life insurance, short-term disability, and long-term disability insurance
• 403(b) Retirement Plan
• Flexible Spending Accounts for medical and dependent care reimbursable expenses
• And much more!

About Us:

Community of Hope?is a?mission-driven,?innovative, and?rapidly growing?nonprofit. For over 40?years, we have provided?healthcare, housing, and supportive services for under-resourced, underserved and people experiencing homelessness in Washington, DC.?As a Federally Qualified Health Center, we provide?medical, dental, emotional wellness, and?care coordination services for the whole family at three locations in DC. Community of Hope also strongly emphasizes maternal and child health, with midwifery practice and the only free-standing birth center in DC.?In 2020, Community of Hope provided about?28,400?medical visits,?7,000?dental visits, and?10,000?behavioral health visits?for about 11,000 patients.? Community of Hope provides community walk-in COVID testing and COVID vaccines. Community of Hope is also one of the largest providers in DC of housing and support services for families and individuals experiencing homelessness.??Through providing these programs, we?live out?our mission?to improve health and end family and individual homelessness to make Washington, DC, more equitable.? 

Community of Hope cares for families and individuals by providing direct services focusing on prevention, healing, and wellness. We improve lives by building on families' and individuals'?strengths, honoring their choices, and taking a whole-family, multi-generational approach. We lead and advocate for system change to address the effects of historical and current racial inequities on health outcomes and housing opportunities. We embrace the diversity of our community, welcome all voices and perspectives, and treat everyone with respect, compassion, and integrity. We strive for excellence in everything we do, implement evidence-based practices, measure our outcomes, and use this knowledge to strengthen our work continuously. We were selected as one of The Washington Post 150 Top Workplaces in 2014, 2016, 2017, 2018, 2020, and 2021 based on feedback from our staff.? 

To request a reasonable accommodation to complete an employment application or for general questions about employment with Community of Hope, contact a Recruiting Coordinator. Email: hr@cohdc.org Phone: 202-407-7747. Community of Hope is an equal opportunity employer.