CNPA Credit & Collection Rep I

Silver Spring, Maryland-Silver Spring
Jul 01, 2021
Aug 05, 2021
Full Time
The Credit & Collections Representative 1 (CP&A) will be responsible to follow-up and find a resolution of guarantor/insured liability in accordance with CP&A Policy and Procedure. Establish and follow-up on guarantor payment agreements. Responsible for incoming calls and telephone coverage to assist caller with questions and complaints using the highest customer service skills. Investigate account and insurance reimbursement questions to the guarantor/caller satisfaction. Ability to resubmit or appeal claims on behalf of the insured as necessary .


Minimum Education
High School Diploma or GED (Required)

Minimum Work Experience
4 years Physician Business Office (Required)

Required Skills/Knowledge
Computer skills using Windows, Payer Web Search, Excel, Word.
Knowledge of insurance billing and reimbursement/patient liability.
Guarantor collections and AR process.
Understanding of managed care contracts and insurance compliance.
Excellent communication (written and oral) and customer service skills.

Functional Accountabilities
Customer Service/Phones
  • Responsible for coverage of incoming calls between 8:00am and 4:30pm.
  • Respond to patient and Practice inquires.
  • Resolve patient questions with Practice/Provider, Insurance and Revenue Cycle Manager as necessary .
Patient Account Review
  • Review account activity to ensure that all insurance including secondary for DOS has been sequenced, filed and credited appropriately.
  • Review statement activity and billing cycle to ensure that the patient is receiving statements with a minimum of two statements prior to collection activity .
  • Document and note all findings and actions taken on account and/or Finance Notes according to CP&A policy
Insurance Follow Up
  • Research questions identified through account evaluation or patient inquiry contacting the payer if necessary.
  • Take necessary action to correct, resubmit or appeal claims denied inappropriately .
  • Consult with insurance follow-up to ensure rebill/appeal actions are appropriate and communicate identified charge errors or payer changes to insurance follow-up.
  • Verify and apply secondary insurance and file claim if applicable.
Guarantor Collections and Payment Arrangement
  • Contact guarantor to collect balance in full for assigned age group/Practice following CBO collection guidelines.
  • Establish payment arrangement based on CBO procedure.
  • Establish a follow-up process to ensure that payment plan agreements are honored.
  • Manage AR age for assigned age/Practice to ensure that guarantor balances are resolved within the expected time frame following CP&A policy.
  • Take necessary steps to recommend transfer to collections if guarantor is not compliant within the promised time frame.
Adjustments/ Collections
  • Process authorized adjustments following CBO procedure.
  • Review unapplied cash and work with Team Leader to transfer if applicable.
  • Transfer authorized accounts to collections following CBO procedure.
  • Document and note all findings and actions taken on account and/or Finance Notes according to CP&A policy.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
  • 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

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

  • 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

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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