Accounting/Finance - Collections Coordinator

COLLECTIONS PROCESS OVERVIEW


ATB


What is an ATB?


ATB stands for aged trial balance and includes all claims for a specific time period that do not have a zero balance.


Why do we do the ATB:


ATB is done as an effort to improve collection rates, reduce bad debt and assist in meeting quarterly reserve risk goals.

ATB Process Details:

• Collections supervisor receives correspondence and EOB's from Cash team.
• Denials are distributed to plan owners who then log them on a spreadsheet, including the denial code, denial reason, and action code and action reason.
• Run ATB query for specific time period. Standard is working 60 days back for the preceding four months.
• V-lookup denials and action codes from denial log spreadsheet.
• Run query to pull in batch and check numbers associated with claims. Research in Filebound for additional denials.
• Research credits to determine whether there are two payments applied to the claim or if there is an overpayment. Determine whether a refund is due to insurance or member. If there is a refund due, complete refund request. If there are two payments applied and one belongs to a different invoice, complete redirect.
• Open claims with no payment, nor denial, see resubmit instructions.
• If a claim has already been resubmitted and still neither payment, nor denial has been received, contact payer to check status of the claim and work towards a resolution.
• Once all actions have been determined, send write offs for approval to supervisor. For all write offs over $1000, they must be approved by finance manager.
• Identify trends within payers to find issues. If there is an issue within plan set up, forward it to be corrected. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.
• Complete all actions: write offs, resubmits, calls, e-mails and post to K: Drive for auditing.

How does this relate to claims?

• Effective claims processes to ensure claim accuracy and workarounds increase likelihood of prompt payment, reducing the ATB and improving collection rates.
• Processes for bill actual plans can affect over/short write offs on the ATB.

Resubs (Part 2 of 2)


Collections process for resubmitting a claim:


A claim will be resubmitted if:

• There was no payment or denial received
• We received a denial instructing a correction to be made

Collections resubmits the claim and waits for Claims to work and deliver to Plan owner. The plan owner would make any necessary corrections to the claim and mail to the Payer. For 837 plans, corrections need to be made in the 400 prior to the claim being resubmitted.

Challenges to resubmitting a claim

• There are no ways to track a resubmitted claim in our system.
• Collections relies on the claims team to make sure they receive the resubmitted claims in order to make proper corrections.

Payment Received After


What is the Payment Received After Query?


The payment received after query pulls claims that have received a payment after the claim had been written off.


When is the Query Worked?


Collections receives the payment received after query every Wednesday from their supervisor. Each team member researches their plans' claims to determine if the payment belongs on the claim. If payment is misapplied, the owner redirects to correct invoice or unapplies payment if correct invoice cannot be determined.