Children's National Medical Center
Credit & Collection Rep II
Children's National Medical Center, Silver Spring, Maryland, United States, 20900
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 callers 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.Qualifications
Minimum EducationHigh School Diploma or GED (Required)
Minimum Work Experience5 years Physician Business Office (Required)
Required Skills/KnowledgeKnowledge 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 AccountabilitiesClaimsReview 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 ProcessReview 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 ProcessDocument 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 DevelopmentUnderstand 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.ARMaintain insurance AR age below 150 days.Work assigned AR and training projects as directed by Team Lead or Manager.Organizational Accountabilities
Organizational Commitment/IdentificationAnticipate and respond to customer needs; follow up until needs are met.Teamwork/CommunicationDemonstrate collaborative and respectful behavior.Partner with all team members to achieve goals.Receptive to others' ideas and opinions.Performance Improvement/Problem-solvingContribute 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 ResponsibilityUse resources efficiently.Search for less costly ways of doing things.Safety
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Minimum EducationHigh School Diploma or GED (Required)
Minimum Work Experience5 years Physician Business Office (Required)
Required Skills/KnowledgeKnowledge 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 AccountabilitiesClaimsReview 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 ProcessReview 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 ProcessDocument 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 DevelopmentUnderstand 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.ARMaintain insurance AR age below 150 days.Work assigned AR and training projects as directed by Team Lead or Manager.Organizational Accountabilities
Organizational Commitment/IdentificationAnticipate and respond to customer needs; follow up until needs are met.Teamwork/CommunicationDemonstrate collaborative and respectful behavior.Partner with all team members to achieve goals.Receptive to others' ideas and opinions.Performance Improvement/Problem-solvingContribute 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 ResponsibilityUse resources efficiently.Search for less costly ways of doing things.Safety
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