The Credit & Collections Rep II (CNPA) will be responsible for insurance follow up and resolution of guarantor/insured liability in accordance with CP&A Policy and Procedure. Establish and follow up on guarantor payment agreements. Responsible for incoming calls and telephone coverage assisting caller with questions and complaints using the highest customer service skills. Investigate account and insurance reimbursement questions to the guarantor's/callers satisfaction. Ability to resubmit or appeal claims on behalf of the insured as necessary.
Minimum Education
High School Diploma or GED (Required)
Minimum Work Experience
5 years Physician Business Office (Required)
Required Skills/Knowledge
Knowledge of insurance billing and reimbursement/patient liability, AR and Revenue Cycle process.
Understanding of managed care contracts and insurance compliance.
High level problem solving skills, subject matter expert, account analysis and resolution.
Ability to multi-task and work independently.
Excellent communication (written and oral) and customer service skills.
Computer skills using Windows, Payer Web Search, Excel, Word.
Functional Accountabilities
Claims
* Review un-adjudicated claims by age and check status with the payer to determine and document the expected payment and time.
* Research missing payments or denials and post once located and documented with Team Leader .
* Verify all registration and billing address data and resubmit claims not on file.
* Process authorized adjustments following CBO procedure.
Claims Process
* Review adjudicated claims with balance pending in insurance responsibility.
* Follow-up potential secondary claim status; bill secondary , if NOF .
* Contact payer for denial explanation
* Correct claim for resubmission, if applicable.
* Create an appeal with documentation, if applicable.
* Move balance to guarantor responsibility, if after review is determined.
Appeals Process
* Document and track open appeals.
* Monitor for trends by payer and/or denial.
* Research validity of denial as compared to NCCI and payer contracts.
* Communicate findings to Manager.
* Attend payer conference/meetings to resolve payer reimbursement issues.
Professional Development
* Understand managed care contracts and apply principles to account activity and insurance collection.
* Attend payer meetings and webinars to stay abreast of changes.
* Communicate new developments to Manager.
* Develop understanding of state/federal assistance programs and surrounding guarantor collections and insurance.
AR
* Maintain insurance AR age below 150 days.
* Work assigned AR and training projects as directed by Team Lead or Manager
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
* Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
* Demonstrate collaborative and respectful behavior
* Partner with all team members to achieve goals
* Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
* Contribute to a positive work environment
* Demonstrate flexibility and willingness to change
* Identify opportunities to improve clinical and administrative processes
* Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
* Use resources efficiently
* Search for less costly ways of doing things
Safety
* Speak up when team members appear to exhibit unsafe behavior or performance
* Continuously validate and verify information needed for decision making or documentation
* Stop in the face of uncertainty and takes time to resolve the situation
* Demonstrate accurate, clear and timely verbal and written communication
* Actively promote safety for patients, families, visitors and co-workers
* Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
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