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.
High School Diploma or GED (Required)
Minimum Work Experience
5 years physician business office experience (Required)
Knowledge of insurance billing and reimbursement/patient
liability, AR and Revenue Cycle process
Understanding of managed care contracts and insurance
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
Computer: Windows, Payer Web Search, Excel, Word Understands
federal and state regulations surrounding guarantor collections and
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
- Follow-up potential secondary claim status. Bill secondary if
- 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
- 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
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
- Communicate new developments to Manager.
- Develop understanding of state/federal assistance
- 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
- 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 (Staff)
- Anticipate and responds to customer needs; follows up until
needs are met
- Demonstrate collaborative and respectful behavior
- Partner with all team members to achieve goals
- Receptive to others' ideas and opinions
- Contribute to a positive work environment
- Demonstrate flexibility and willingness to change
- Identify opportunities to improve clinical and administrative
- Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
- Use resources efficiently
- Search for less costly ways of doing things
- Speak up when team members appear to exhibit unsafe behavior or
- Continuously validate and verify information needed for
decision making or documentation
- Stop in the face of uncertainty and takes time to resolve the
- Demonstrate accurate, clear and timely verbal and written
- Actively promote safety for patients, families, visitors and
- Attend carefully to important details - practicing Stop, Think,
Act and Review in order to self-check behavior and performance