Claims Processing Rep (CNPA)

The Claims Processing Rep (CNPA) will be responsible to evaluate and correct registration and charge data in accordance with insurance standards and CNPA billing policy and procedure. Communicate with Practice Managers and Revenue Cycle Manager for process improvement.

• Verify the insurance sequence is correct and re-sequence if incorrect.

• Verify system indicates insurance is active.

• Communicate invalid insurance errors to Practice Manager and Revenue Cycle Manager.

• Verify that CPT, age and gender coordinate and are valid; make corrections following CP&A policy and procedure.

• Correct modifiers according to payer specifications; apply missing modifiers according to CP&A policy/procedure.

• Verify that immunizations billed are listed on the Medical Record for DOS tasking the provider when conflicts are identified.

• Apply patient incentive credit according to Practice note.

• Process a minimum of 500 line items per day.

• Resolve charges within two days (2) of receipt.

• Maintain a maximum error rate of 2% per daily line item total per day.

• Communicate Task Message to Providers, Practice Managers and Revenue Cycle Managers with accuracy and professionalism.

• Identify trends in charge and registration errors and report findings with examples to Manager.

• Understand managed care contracting requirements and apply principles to billing.

• Develop detailed understanding of state/federal assistance programs, e.g., Medicaid

• Understand federal and state regulations surrounding billing.

• 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

• 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

• 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