Children's National Health System
Claims Processing Rep (CNPA)
Children's National Health System, Silver Spring, MD, United States
Description
High School Diploma or GED (Required)
Minimum Work Experience
1 year Related Medical Office or Healthcare Billing Trade Certification. (Required)
Functional Accountabilities
Registration Review
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
Teamwork/Communication
Performance Improvement/Problem-solving
Cost Management/Financial Responsibility
Safety
The Claims Processing Rep (CNPA) will be responsible to evaluate and correct registration and charge data in accordance with insurance standards and CNPA billing policy and procedure. Communicate with Practice Managers and Revenue Cycle Manager for process improvement.
Qualifications Minimum EducationHigh School Diploma or GED (Required)
Minimum Work Experience
1 year Related Medical Office or Healthcare Billing Trade Certification. (Required)
Functional Accountabilities
Registration Review
- Verify the insurance sequence is correct and re-sequence if incorrect.
- Verify system indicates insurance is active.
- Communicate invalid insurance errors to Practice Manager and Revenue Cycle Manager.
- Verify that CPT, age and gender coordinate and are valid; make corrections following CP&A policy and procedure.
- Correct modifiers according to payer specifications; apply missing modifiers according to CP&A policy/procedure.
- Verify that immunizations billed are listed on the Medical Record for DOS tasking the provider when conflicts are identified.
- Apply patient incentive credit according to Practice note.
- Process a minimum of 500 line items per day.
- Resolve charges within two days (2) of receipt.
- Maintain a maximum error rate of 2% per daily line item total per day.
- Communicate Task Message to Providers, Practice Managers and Revenue Cycle Managers with accuracy and professionalism.
- Identify trends in charge and registration errors and report findings with examples to Manager.
- Understand managed care contracting requirements and apply principles to billing.
- Develop detailed understanding of state/federal assistance programs, e.g., Medicaid
- Understand federal and state regulations surrounding billing.
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