Patient Account Receivables Specialist

Patient Account Receivable Specialists

Are you excited about a new opportunity Do you have a passion for delivering high quality service Are you missiondriven to help towards improving health and eliminate inequities in health outcomes in underresourced communities in DC 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!

Our mission: To improve health end homelessness and partner with communities to make Washington DC more equitable.

Our Approach and Values:

We celebrate peoples strengths and acknowledge the impact of trauma on peoples lives.

We embrace diversity welcome all voices and treat everyone with respect and compassion.

We lead and advocate for changes to make systems more equitable.

We strive for excellence and value integrity in all that we do.

Position Summary:

The Patient Account Receivable Specialist is responsible for following up on outstanding claims in a timely manner according to the assigned inventory and followup guidelines. They will completes denials and appeals within set guidelines as well as

identifying insurance refunds and submits them to the Billing Lead for review and approval. The Patient Account Receivables Specialist is accountable directly to the Billing Lead.

Salary Indeed provides its own estimated salary calculator and is not affiliated with COHs range. The salary range for this position is $24.03 $26.44 per hour.

Highlighted Duties and Responsibilities:

• Works claims to ensure billing is completed within 5 days of the claim date to stay within timely filing guidelines of each payer daily. Correcting errors to ensure claims are going out clean (check eligibility/demographics using payer web portals checking modifiers ICD 10 placement converting claims be sure insurance is checked and ensure correct placement of insurance i.e. primary secondary tertiary. Submits claims daily to ensure claims are billed in a timely manner so that claims are not adjusted off as timely filing on Board Write Off.
• Reviews and works the following status under Eligibility issues pending pending with errors insurance accepted insurance rejected coding issues all the HCFAs mailed refund to payer payment in route wrap suspend. Claims should not be in that status code any longer than 1014 days. Identifies patterns and addresses with Billing Manager.
• Able to expedite claim adjudication by resolving issues in ERA Denied Rejections and other aged claims within 21 days since the claim placed in the above status code. Research errors and make necessary edits to claims that will make the claim ready for submission. If it involves the patient and/or guarantor make contact by phone and/or letter 2448 hours from issue being identified.
• Calls insurance companies daily and as needed to determine when payments will be made and determines if any additional information is required to process adjudicated claims. Notates practice management software (eCW) stating the following: who was contacted what was found and how it was corrected.
• Daily ProductivityBilling minimum of 50 60 claims daily. Follow up for MCO payers a minimum of 40 50 claims daily. Commercial and Medicare follow up a minimum of 3040 claims daily.
• Handles complex denials by researching extensively and calling insurance patients and reviewing regulations daily and as needed. Contacts insurance to verify Coordination of Benefits (COB) eligibility check timely filing and making sure the claim processes accurately.
• Follow up on high dollar claims over $3000 including Birth and Dental claims every 21 days.
• Contact the patient with the required number of contacts in order to resolve the patients demographics and/or insurance daily or as needed. 1. Call the patient 2. Send Letter to patient 3.Email the patient if email is on file with limited information. 4.Send Action to PM 5. Call insurance to see if the issue is resolved. 6. Email the PM/EA). Coordination of Benefits will be placed on hold until directed to move forward.
• Provides feedback to the Leads regarding any issues or repetitive errors that may be encountered during claim review and submissions during weekly meetings. This should be documented on a master log and frontend log.
• Reviews and proposes a minimum of 10 refunds/voids per week depending on payer guidelines. Refunds to be sent to the Billing Manager for approval and processing.
• Responds to staff management payers and vendors within 12 business days which includes email voicemail chat etc.
• Identifies denied services based on the type or level of service medical necessity of a covered benefit.
• Coordinate daily or as needed within denials process with each payer in accordance with the payers guidelines on authorization incorrect payments timely manner etc. Works with Billing Lead and Billing Manager on coordinating denials with insurance representatives and if denials proceeds into an appeal. Also ensures claims do not fall into Timely Filing for adjustments.
• Reviews remittance advice for payment discrepancies and takes appropriate action for resolutions within 3 days. Any posting errors should be emailed to the poster with the required documentation.
• Assigned to answer patients billing calls via phone system and collect payments on a rotating schedule for a weeks time as assigned by the Billing Manager. Credit card payments collected are processed through Pay Trace. Calls that are not billing associated will need to be routed to the appropriate Departments at COH such as Medical Emotional Wellness Birth and Dental.
• Reviews and responds to all insurance correspondence within 5 business days of receipt or scanned in by Leaders. Urgent or time sensitive correspondence should be addressed within same business day of received if time permits but at maximum the next business day and coordinated with others on response as needed.
• Handles sensitive information with care and discretion to ensure confidentiality: Includes verifying patients identity when speaking on the phone.
• Completes other duties and projects as assigned by supervisor.*

Minimum Requirements

• High School diploma required. Some college studies or Associates degree preferred.
• Healthcare experience with Medicare and DC Medicaid is strongly required/preferred.
• 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 fastpaced environment.
• Superior knowledge of computers including MS Office Practice Management Systems (eClinicalWorks) payers website navigation and contract management.
• Able to perform basic and mathematical calculations works credits on accounts and able to reconcile data.
• Proof of vaccination against COVID19 is required. COH will consider requests for reasonable
• accommodations for anyone who cannot be vaccinated for a religious or medical reason subject to applicable law.

At COH we prioritize the following wellbeing and worklife balancecentered benefits:

• Remote work opportunities are available for many but not all of our roles promoting a culture of worklife balance.
• 8hour 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 25 after 10 years of service and 30 after 15 years of service) and 12 days of paid sick leave on an annual basis
• Annual performancebased 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
• Ongoing wellbeing activities culture compact activities and training and traumainformed care initiatives and training
• Medical/Dental/Vision Plans through CareFirst BlueCross Blue Shield
• Life insurance shortterm disability and longterm disability insurance
• 403(b) Retirement Plan
• Flexible Spending Accounts for medical and dependent care reimbursable expenses
• And much more!
• In relation to remote work versus onsite 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.

About Us:

Community of Hope is a missiondriven innovative and rapidly growing nonprofit. For 45 years we have provided healthcare housing and community support services to make Washington DC more equitable. 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 freestanding birth center in DC. In 2024 Community of Hope provided about 50000 medical visits 6300 dental visits and 17000 behavioral health visits for about 16000 patients. Community of Hope is also one of the largest providers of homelessness prevention and housing services for 1600 households1384 families and 220 individualsexperiencing homelessness in DC. Community support through Family Success Center our WIC nutrition centers and perinatal care coordination for pregnant people experiencing homelessness reach hundreds more families. We believe that everyone in DC can be healthy housed and hopeful.

We were selected as one of The Washington Post 150 Top Workplaces in 2024 and 6 other times since 2014 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: Phone:. Community of Hope is an equal opportunity employer.