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Credit & Collection Coordinator (CNPA)

Company: Children's National Medical Center
Location: Silver Spring
Posted on: June 6, 2021

Job Description:

The Credit & Collections Coordinator (CP&A) will be responsible for the follow-up with insurance carriers to facilitate appropriate reimbursement. Will investigate reasons for low or non-payment and provide necessary documentation to insurance carriers. Will develop and follow-up on letters for appeal to support payment of denied claims. Will document activities and contacts in the system. Will develop detailed understanding of assigned managed care contractor and payer requirements. Will track, report and communicate payment trends and policy changes. Credential, revalidate, and maintain documentations for CP&A providers with all commercial, Medicaid, and MCO payers via delegated credentialing rosters and CAQH.

Minimum Education

High School Diploma or GED (Required)

Minimum Work Experience

5 years physician business office experience (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: Windows, Payer Web Search, Excel, Word Understands federal and state regulations surrounding guarantor collections and insurance

Functional Accountabilities

Follow-Up Submitted 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

Appeal Tracking, Trending and Reporting

  • 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 that is determined.

Adjustments

  • Process authorized adjustments following CBO procedure.

AR Age and Projects

  • Maintain insurance AR age below 150 days.
  • Work assigned AR and training projects as directed by Team Lead or Manager

Managed Care Contracts and Federal/State compliance

  • 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.

Provider Enrollment

  • Send delegated payer roster with additions, changes, and deletions on a bi-weekly basis.
  • Create and complete CAQH applications for providers, including attestations for new and revalidating providers.
  • Update credentialing grid for each site and provider on the shared drive and updates managers with status on a monthly basis.
  • Provide Practice Administrator with new provider IDs to be updated in Intergy for claims release.
  • Monitor new provider payer enrollments through follow-up contacts and revalidates as needed.
  • Monitor on-hold claim totals and outstanding claims for new providers upon enrollment completion date.

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

Keywords: Children's National Medical Center, Silver Spring , Credit & Collection Coordinator (CNPA), Other , Silver Spring, Maryland

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