Claims Collections Associate

Job Description

Job Description

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 difference 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

About company - Since its founded in 1996, CTC has grown into a trusted global partner in AI & ML, Enterprise Applications, Digital Services, Managed Services, and Business Services. With headquarters in Detroit, Michigan, CTC has a team of over 2,000 experts worldwide. We empower more than 100 organizations to tackle complex challenges and transform them into sustainable competitive strengths--driving innovation, efficiency, and growth every step of the way. Our strengths have always been Commitment to Customer, Commitment to Colleagues, and Commitment to Community (CTC).

Company Description

About company - Since its founded in 1996, CTC has grown into a trusted global partner in AI & ML, Enterprise Applications, Digital Services, Managed Services, and Business Services. With headquarters in Detroit, Michigan, CTC has a team of over 2,000 experts worldwide. We empower more than 100 organizations to tackle complex challenges and transform them into sustainable competitive strengths--driving innovation, efficiency, and growth every step of the way. Our strengths have always been Commitment to Customer, Commitment to Colleagues, and Commitment to Community (CTC).