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 mission-driven to help towards improving health and eliminate inequities in health outcomes in under-resourced 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!

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 Patient Account Receivable Specialist is responsible for following up on outstanding claims in a timely manner according to the assigned inventory and follow-up 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 pay rate for this position ranges between $24.03 - $26.44 per hour and the offer amount is determined by the candidate's education, qualifications, and experience. really provides their own estimated salary calculator and is not affiliated with COH's range.

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 10-14 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 24-48 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 Productivity-Billing 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 30-40 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 $3,000 including Birth and Dental claims every 21 days.
• Contact the patient with the required number of contacts in order to resolve the patient’s 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 front-end 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 1-2 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 week’s 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 fast-paced environment.
• Superior knowledge of computers including MS Office, Practice Management Systems (eClinicalWorks) payer’s 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 COVID-19 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 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
• 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 wellbeing 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!
• 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.

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.