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 Education
High 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.
Charge Data Verification and Posting
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.Productivity & Quality
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.Program Knowledge
Understand managed care contracting requirements and apply principles to billing.Non- Essential Function
Develop detailed understanding of state / federal assistance programs, e.g., MedicaidUnderstand 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 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 performance
