Job Description - Senior Collections Representative (2400019F)
Description
The person in this position will be responsible for monitoring and researching cases that are in-house and on the discharged not final billed report to mitigate any potential denials and ensure that claims are clean before billing. The individual will work closely with Clinical Resource Management (CRM) to ensure cases reflect the correct clinical level of care and ensure clinical information is received by the insurance carrier for timely level of care authorizations by the payers. Monitor and report payer authorization delays and stall tactics as they occur. Follow-up with all insurance carriers to facilitate timely and correct reimbursement for high balance cases. Investigate and report reasons for non-payment and delays. Perform root cause analysis of the various trends identified. Write appeals to recover denied and underpaid claims. Support the payer escalation process by ensuring high balance cases are prepared for outsourcing to attorneys. Gather documentation and summarize issues for the attorney.
Qualifications
High School Diploma or GED (Required)
Minimum Work Experience
5 years related patient accounting experience required, especially related to denial mitigation, root cause analysis, and LOC reconciliation. (Required)
Functional Accountabilities
- Pre-Billing
Review inpatient cases before billing to ensure that leveling, authorization, eligibility, and any other functions ensure a clean claim is released for billing. - Continuously monitor the pending report with CRM to ensure issues are resolved in a timely manner.
- Maintain OP DNFB to include updating DX codes from PPM.
- Analyze and Report
Conduct root cause analysis of issues reducing reimbursement & slowing payment cycle; identify key issues and assist in tracking, trending and reporting; identify and clearly communicate deficiencies and resolutions of issues impacting reimbursement; respond in a timely fashion to any deviation from established and required processes and standards. - Conduct analysis on a wide variety of issues related to billing, collections, and denial processes; make process improvement recommendations based on findings; interact at all levels of CNMC, including senior management.
- Assist in the development of solutions, training & education to resolve issues and share data with staff and management.
- Continuously work to improve the design and performance of the established reporting and tracking systems.
- Appeal
Ensure all high dollar denials & underpayments are appealed & followed up timely; ensure maximum recovery of reduced reimbursement. - Manage large volumes of denials, denial amounts, and various appeal deadlines to prioritize workload and maximize reimbursement.
- Process individual denials and ensure written appeals are clear, concise, and within timely appeal limits.
- Collection Support
Check for payment posting and receive a list of unpaid claims from the system; proactively follow-up on submitted claims to determine payment status through telephone or web contact in a timely manner; collect information from carriers about what specific documentation is needed to pay claims. - Contact internal departments (Health Information Management, Clinic Operations) for information and documentation to facilitate claim payment; provide documentation via fax, phone or mail to payer, e.g., operative reports.
- Track appeals of denied claims to determine status and work with carriers for payment; resubmit claims if the payer does not have a record of the claim.
- Prioritize work to facilitate payment of higher account balances.
- May follow-up with parents, if insurance has paid parents to receive reimbursement.
- May recommend adjustments and write-offs to bill within identified parameters; refer to manager as appropriate.
- Safety
Speak up when team members exhibit unsafe behavior or performance. - Continuously validate and verify information needed for decision making or documentation.
- Stop in the face of uncertainty and take 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.
Organizational Accountabilities
- Anticipate and respond to customer needs; follow 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 processes.
- Make appropriate decisions, using sound judgment.
- Use resources efficiently.
- Search for less costly ways of doing things.
Primary Location: Maryland-Silver Spring
Work Locations: Tech Hill 12211 Plum Orchard Drive Silver Spring 20904
Job: Accounting & Finance
Organization: Finance
Position Status: R (Regular) - FT - Full-Time
Shift: Day
Work Schedule: 80
Job Posting: May 6, 2024, 3:52:00 PM
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