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Credit and Collections Representative II

1 month ago

Silver Spring, Maryland, United States Children's National Hospital Full time
Job Summary

The Credit and Collections Representative II will be responsible for insurance follow-up and resolution of guarantor/insured liability in accordance with CP&A Policy and Procedure. This role will establish and follow up on guarantor payment agreements, investigate account and insurance reimbursement questions, and resubmit or appeal claims as necessary.

Key Responsibilities
  • 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.
  • Process authorized adjustments following CBO procedure.
Claims Process
  • 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 is determined.
Appeals Process
  • Document and track open appeals.
  • Monitor for trends by payer and/or denial.
  • Research validity of denial as compared to NCCI and payer contracts.
  • Communicate findings to Manager.
  • Attend payer conference/meetings to resolve payer reimbursement issues.
Professional Development
  • 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 and surrounding guarantor collections and insurance.
AR
  • Maintain insurance AR age below 150 days.
  • Work assigned AR and training projects as directed by Team Lead or Manager.
Organizational Accountabilities
Organizational Accountabilities (Staff)
  • 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.