Professional Billing Representative (PRN | As Needed)

Kids Are Our Everything.

Department

Pay Range

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 Experience
2 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 not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.