Description
The Credit & Collections Representative 1 (CNPA) will be responsible to follow-up and find a resolution of guarantor / insured liability in accordance with CNPA Policy and Procedure. Establish and follow-up on guarantor payment agreements. Responsible for incoming calls and telephone coverage to assist caller with questions and complaints using the highest customer service skills. Investigate account and insurance reimbursement questions to the guarantor / caller satisfaction. Ability to resubmit or appeal claims on behalf of the insured as necessary .
Qualifications Minimum Education
High School Diploma or GED (Required)
Minimum Work Experience
4 years Physician Business Office (Required)
Required Skills / Knowledge
Computer skills using Windows, Payer Web Search, Excel, Word.
Knowledge of insurance billing and reimbursement / patient liability.
Guarantor collections and AR process.
Understanding of managed care contracts and insurance compliance.
Excellent communication (written and oral) and customer service skills.
Functional Accountabilities
Customer Service / Phones
- Responsible for coverage of incoming calls between 8 : 00am and 4 : 30pm.
- Respond to patient and Practice inquires.
- Resolve patient questions with Practice / Provider, Insurance and Revenue Cycle Manager as necessary .
Patient Account Review
Review account activity to ensure that all insurance including secondary for DOS has been sequenced, filed and credited appropriately.Review statement activity and billing cycle to ensure that the patient is receiving statements with a minimum of two statements prior to collection activity .Document and note all findings and actions taken on account and / or Finance Notes according to CP&A policyInsurance Follow Up
Research questions identified through account evaluation or patient inquiry contacting the payer if necessary.Take necessary action to correct, resubmit or appeal claims denied inappropriately .Consult with insurance follow-up to ensure rebill / appeal actions are appropriate and communicate identified charge errors or payer changes to insurance follow-up.Verify and apply secondary insurance and file claim if applicable.Guarantor Collections and Payment Arrangement
Contact guarantor to collect balance in full for assigned age group / Practice following CBO collection guidelines.Establish payment arrangement based on CBO procedure.Establish a follow-up process to ensure that payment plan agreements are honored.Manage AR age for assigned age / Practice to ensure that guarantor balances are resolved within the expected time frame following CP&A policy.Take necessary steps to recommend transfer to collections if guarantor is not compliant within the promised time frame.Adjustments / Collections
Process authorized adjustments following CBO procedure.Review unapplied cash and work with Team Leader to transfer if applicable.Transfer authorized accounts to collections following CBO procedure.Document and note all findings and actions taken on account and / or Finance Notes according to CP&A policy.Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment / Identification
Anticipate and responds to customer needs; follows up until needs are metTeamwork / Communication
Demonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement / Problem-solving
Contribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management / Financial Responsibility
Use resources efficientlySearch for less costly ways of doing thingsSafety
Speak up when team members appear to exhibit unsafe behavior or performanceContinuously validate and verify information needed for decision making or documentationStop in the face of uncertainty and takes time to resolve the situationDemonstrate accurate, clear and timely verbal and written communicationActively promote safety for patients, families, visitors and co-workersAttend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performancePrimary Location : Maryland-Silver Spring Work Locations : Tech Hill 12211 Plum Orchard Drive Silver Spring 20904 Job : Accounting & Finance Organization : Childrens Peds and Assoc Position Status : R (Regular) - FT - Full-Time Shift : Day Work Schedule : Full-Time Job Posting : Jan 24, 2025, 3 : 58 : 41 PM Full-Time Salary Range : 40664 - 67787.2
