Professional Billing Representative; PRN

12211 Plum Orchard Drive Silver Spring, MD 20904

Kids Are Our Everything.

Department
10121 Patient Cash Application Pay Range $18.54 - $30.89

About the Role:

The Professional Billing Specialist will be responsible to ensure physician 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 professional service claims to include hospital, specialty and primary care based services. Will develop detailed understanding of assigned managed care contractor and payor requirements.

Will track and report billing trends with assigned carriers.

What You’ll Bring :

Minimum Education High School Diploma or GED (Required)
Associate's Degree Associates Degree/Healthcare Billing Vocational Training. (Preferred)
Minimum Work Experience2 years Professional service billing or related education in a physician clinic practice or billing office. (Required)
Required Skills/Knowledge Analytical problem solver, detail oriented, efficient, and productivity driven.

Ability to process large volumes on a daily basis.

Functional Accountabilities Queue Management Monitor claims outstanding and 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.

Maintain age less than 5 days from import.

Process 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 share 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.Why Join Us:
• Nationally Recognized Excellence – Consistently ranked among the Top 10 Children’s Hospitals in the nation by U.S. News & World Report.
• Leading Pediatric Care

– One of the largest and most comprehensive children’s hospitals in the country, offering nationally ranked specialties and cutting-edge treatments.
• Innovation & Research – A premier academic medical center with a strong commitment to pediatric research, education, and advancing the future of child health.
• Mission-Driven Culture – Dedicated to providing family-centered care while fostering a collaborative, supportive environment for clinical teams.

The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is…