A/R Revenue Cycle Specialist

1 month ago

Middle River, United States Johns Hopkins University Full time

We are seeking an A/R Revenue Cycling Specialistwho will be responsible for the basic collection of unpaid third-party claims and standard appeals, using various JHM applications and JHU/ PBS billing applications. This role communicates with payers to resolve issues and facilitate prompt payment of claims. Follows up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claim's submission process, either electronically or by paper. Recognizes and resolves incorrect demographic and insurance registration based on an understanding of the outpatient registration process. Will use an understanding of claims submission requirements for payors in order to expedite payments and possess a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior specialist.

Specific Duties & Responsibilities

  • Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
  • Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
  • Review and update patient registration information (demographic and insurance) as needed.
  • Resolves claim edits as needed.
  • Applies appropriate discounts / courtesies based on department policy.
  • Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
  • Prints and mails claim forms and statements according to the follow-up matrix.
  • Retrieves supporting documents (medical reports, authorizations, etc) as needed and submits to third-party payers.
  • Appeals rejected claims and claims with low reimbursement.
  • Performs claim edits as needed.
  • Confirm credit balances and gathers necessary documentation for processing refund.
  • Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
  • Contacts the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
  • Monitor invoice activity until problem is resolved.
  • Process daily mail, edits reports, file or pull EOB batches.
  • Identifies and escalates non-standard appeals to a higher-level specialist.
  • Informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
  • Participate in on-going educational activities.
  • Keep current of industry changes by reading assigned material on work related topics.
  • Complete three days of training annually.

Service Excellence

  • Must adhere to Service Excellence Standards

o Customer Relations

o Self-Management

o Teamwork

o Communications

o Ownership/Accountability

o Continuous Performance Improvement

Minimum Qualifications
  • High School Diploma or graduation equivalent.
  • One year experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.

Classified Title: AR Revenue Cycle Specialist
Job Posting Title (Working Title):A/R Revenue Cycle Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.50 - $25.00 HRLY ($43,680 budgeted; commensurate with experience)
Employee group: Full Time
Schedule: Mon-Fri 8:00 am-5:00 pm
Exempt Status:Non-Exempt
Location:Hybrid/JH at Middle River
Department name: SOM OB GYN Production Unit Billing
Personnel area: School of Medicine

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