Best Practices for Billing Collection Specialists

As a billing collections specialist, your primary focus is to resolve claim-related roadblocks one by one. It's also essential to accurately label your claims in the Kipu RCM, enabling managers and team leads to identify trends related to payers, services, individuals, and teams. This information helps them address the challenges you face more effectively.

Audience

• Billing Collection Specialists are responsible for checking payer portals and completing payer phone calls.
• Billing managers make sure that the right people are working claims based on their skill and experience. Divide the claim follow-up team into two tiers based on experience and types of calls. More complicated issues that arise during these calls should be escalated to the Tier 2 billers, who are more capable of troubleshooting claim problems over the phone.

  Tier 1	Tier 2
  Portal Checks	Prior Authorization discrepancies
  Initial Claim Calls	Inconsistent reimbursement rates and pricing issues
  Confirming status of additional inquiries or reviews	Payer system issues
  Requesting EOB's or reimbursement data	Benefits misquotes
  	Contracting discrepancies

Process Overview

Role	Daily	Weekly
Collection Specialists	Payer Reviews Payer Portal Checks Make phone calls to the Payer. Documentation Document all appropriate communications with the payer.  Update claim statuses to reflect the information obtained.	Administrative Tasks Update each claim's QSI and notes with information obtained through payer interactions.

Collection Specialist Daily Tasks

Let's review a billing collection specialist's daily tasks together!

• Step	Action	Helpful Hints
  Set up your Work Center	Go to Work Center > Insurance Claim > Work Claims Filter to “Payer” Queue Expand assigned payers Open each patient in a new tab	Sort by payer to allow you to check multiple claims in the same portal at once. Create a template to quickly set the filters to the view you want to use.
  Check the Portal	Login to the portal Check for available updates if none are available, call the payer Make notes of actions taken and information obtained	Create an Excel spreadsheet with each payer's portal information and other pertinent information such as hours of operation, emails, etc.
  Note-taking	Take detailed notes using a template	Create and use a template for note-taking to expedite the process and to ensure uniformity in claim notes across the team.
  Repeat for as many claim status checks in the portal until complete.

• Step	Action	Helpful Hints
  Prep for the call	Review previous notes (if available) Check payer portal first (if available) If payer status is updated in the portal, skip to step Note Taking	Familiarize yourself with the claim before calling for claim status. Checking the payer portal first might save you a phone call altogether.
  Call the payer	Give patient details to the automated message Get to a live rep to check claim status Set the stage for the live rep	Each type of call should have a “set the stage” guide which allows for the call to be expedient and goal-oriented ensuring consistency in the type of information everyone obtains for each item.
  Note-taking	Take detailed notes using a template	Create and use a template for note-taking to expedite the process and make sure there is uniformity in claim notes across the team.
  Repeat for as many claim status checks as the rep will allow

• Step	Action	Helpful Hints
  Update the RCM	Right-click the claim number to open the Work Claim screen in a separate tab  Add Notes for each claim Under Status, click edit to update claim status Update Claim Follow-Up Date	Use Bulk Update in the Work Center to edit all of these fields at once for multiple claims, if they all have the same outcome. Update your follow-up date for the next time you want to follow up on the claim. A good rule of thumb for setting follow-up dates is 20-30 days after claim submission, or 7-14 days after the last status check. Follow-up dates are automated when the claim is first submitted, resubmitted, rejected, and paid. See Best Practices for Updating Claim Workflow
  Identify Problems and Triage	Add Claim Issue (optional) Update Claim Queue (optional)	Updating claim issues and queues are critical to move claims forward in the adjudication process. Any claim older than 30 days outstanding should be tagged with a claim issue. See Best Practices for Updating Claim Workflow
  Move on to the next assigned payer to call

Collection Specialist Weekly Tasks

It's important to note that some of a billing collection specialist's weekly tasks overlap with their daily tasks.

• Step	Action	Helpful Hints
  Set up your Work Center	Work Center > Insurance Claim > Work Claims Filter to “Administration” Queue Filter to “Open, Assigned to Me” Open a patient in a new tab Sort by follow-up date	See Best Practices for Updating Claim Workflow
  Prep for the task	Review previous notes Assemble requested documentation Prepare to mail/fax/email to the payer
  Update the RCM	Add Notes for each claim into the RCM Update Claim Status Update Claim Follow-Up Date
  Neutralize Triage	Edit/Remove Claim Issue Update Claim Queue
  Move on to the next patient/task