Guides collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results. Works under moderate supervision.
• Ensures the coordination of invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone.
• Researches and resolves denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes.
• Provides guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols.
• Utilizes various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity.
• Oversees accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyzes and clears payment variances. May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting.
• Evaluates, analyzes and monitors the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel, Microsoft Access and other software as necessary to ensure prompt payment.
• Contacts providers, physicians, and/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer.
• Provide payers with detailed itemization of services performed to ensure timely reimbursement. Review EOPs/EOMBs/EOBs for accuracy of patient responsibility.
• Provide input on accounts receivable process improvements and assisting in their implementation.
• Prepares Ad Hoc financial reports for management to use in the evaluation of accounts receivable performance.
• Participates in teleconferences covering a wide range of topics that enables the NBC to effectively collect account receivables.
• Assist Lead Collector with training of newly hired associates and re-education of collection teams as necessary.
• Acts as an information resource for hard to collect accounts and a “grey area” subject expert. Ensures the coordination of special handling or reconciliation of spreadsheets for national payers.
• Monitors team results to ensure they are aligned with departmental goals.
• Works with internal customers to identify issues which may result in new enhancements or platforms as necessary.
• Assures the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards.
• Participates in special projects and performs other duties as assigned.
ATTRIBUTES / QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
• Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
• Reviews and adheres to all company policies, procedures, and the Employee Handbook.
• Must be able to remain in a stationary position 90% of the time.
• Occasionally move about the office to access file cabinets, office machinery, etc.
• Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).
• Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.
• Occasionally lift items weighing up to 10 pounds.
High School Diploma or the equivalent plus a minimum of 3 years medical claims processing experience generally required. Knowledge of healthcare collection procedures and related software applications are required. Effective analytical and communication skills also required as well as knowledge of HIPPA, The Fair Credit and Collections Act, HCPC, CPT, ICD-9 coding, intermediate competency of Microsoft Office Applications, and mathematical calculations. Knowledge of Utilization Management and URAC standards.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.