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Collections Representative
Ref No.: 18-09272
Location: Philadelphia, Pennsylvania
`Responsible for ensuring correct and timely reimbursement from third party payors for services provided. (CAA). The Collections Rep will appeal, re-bill, and perform other necessary actions to collect revenue due CAA. The Collections Rep will be involved in other AR related projects on a daily basis. The Collections Rep will employ appropriate resources to investigate, analyze, identify and reduce barriers to correct adjudication, such as issues involving Network Set-Up, Fee Schedules, Denial Management, and Contract Compliance. The primary focus of this position is to maximize reimbursements through the timely follow up of accounts.

1. Proven working experience as a Collections/Account Receivable Rep

2. Solid understanding of insurance follow-up, denials, reimbursements, contracts and insurance policies

3. Investigate Accounts identified as low pays, denials, or otherwise (75%)
• Review accounts in work file/queue and take appropriate steps to resolve accounts in compliance with CAA's contracts, agreements, or appropriate measures.
• Contact insurance company/third parties by telephone, letter, fax, e-mail, etc. as needed.
• Include complete and appropriate comments on actions taken to resolve accounts.
• Review and perform analysis and trending to identify possible barriers to correct and timely claim submission, claim processing, provider enrollment, among others which may result in non-payments, delayed payments, or low payments.
• Transfer accounts when necessary and only after confirming updated registration or eligibility.
• Ensure that all claim submissions, appeals, and requested information is provided within the required time frame to avoid timely filing issues and processing delays.
• Properly handle all other insurance explanation of benefits that require other activities or reconciliation.
• Request and include correct and appropriate attachments as required and in accordance with policies and procedures.
• Assist with special projects, audits and reconciliation as necessary.

4. Reconcile credit balances and submit requests for refunds in accordance with policies or when applicable or contact Payor to initiate off-sets/retractions of incorrectly paid services when possible. (15%)

5. Investigate and submit for approval write off allowances and/or adjustments that have reasonable justification in accordance with CAA's contracts and policies. (10%)

6. Interact professionally and productively with Co-workers and  staff in areas such as registration, Physician Billing, and Patient Access and Revenue Cycle, and others.

7. Meet minimum production and performance target goals.

8. Work correspondence daily.

7. Other duties as assigned.

• Knowledge of word processing, electronic mail, and spreadsheet applications.
• Must be proficient in Microsoft Excel. Must be comfortable working with large data sets.
• Excellent analytic skills.
• Excellent interpersonal and organization skills.
• Ability to handle multiple tasks, meet deadlines and handle confidential materials.
• Excellent phone etiquette. Strong customer service and phone skills.
• Epic experience is preferred