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AR Revenue Cycle Specialist II

1 month ago

Middle River, United States Johns Hopkins University Full time

We are seeking a

AR Revenue Cycle Specialist II

responsible for the collection of unpaid third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/ PBS billing applications. Will conduct on-line research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures. Communicates with payers to resolve issues and facilitate prompt payment of claims. Follow-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. The AR Revenue Cycle Specialist II will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The AR Revenue Cycle Specialist II will research and interpret medical policies regarding denials based on medical necessity. Will use a working knowledge of local coverage determinations (LCD's) to research and apply appropriately. Will mentor and advise junior specialists as appropriate. 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. Drafts and resolves non-standard appeals. Research medical policies to resolve denials based on medical necessity. Researches and applies LCD's. Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures. 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. 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. Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues. Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims and non-standard appeals. Professional & Personal Development 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. Must adhere to Service Excellence Standards. Customer Relations. Self-Management. Teamwork. Communications. Ownership/Accountability. Continuous Performance Improvement. Knowledge, Skills & Abilities Ability to use various billing and patient information computer systems. Knowledge of various payer processing and submission guidelines. Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions. Comprehensive knowledge of and compliance to HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). Comprehensive knowledge of medical billing applications. Utilize online resources to research policy and regulations to facilitate efficient claims processing. Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures. Excellent interpersonal, communication and customer service skills required. Knowledge of medical terminology, CPT codes and diagnosis coding. Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials. Ability to perform on-line research and analyze data for conclusive thought. Physical Requirements Able to sit in a seated position for extended periods of time. Able to reach by extending hand(s) or arm(s) in any direction. Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard. We are seeking a

AR Revenue Cycle Specialist II

responsible for the collection of unpaid third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/ PBS billing applications. Will conduct on-line research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures. Communicates with payers to resolve issues and facilitate prompt payment of claims. Follow-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. The AR Revenue Cycle Specialist II will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The AR Revenue Cycle Specialist II will research and interpret medical policies regarding denials based on medical necessity. Will use a working knowledge of local coverage determinations (LCD's) to research and apply appropriately. Will mentor and advise junior specialists as appropriate. 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. Drafts and resolves non-standard appeals. Research medical policies to resolve denials based on medical necessity. Researches and applies LCD's. Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures. 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. 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. Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues. Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims and non-standard appeals. Professional & Personal Development 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. Customer Relations. Self-Management. Teamwork. Communications. Ownership/Accountability. Continuous Performance Improvement. Knowledge, Skills & Abilities Ability to use various billing and patient information computer systems. Knowledge of various payer processing and submission guidelines. Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions. Comprehensive knowledge of and compliance to HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). Comprehensive knowledge of medical billing applications. Utilize online resources to research policy and regulations to facilitate efficient claims processing. Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures. Excellent interpersonal, communication and customer service skills required. Knowledge of medical terminology, CPT codes and diagnosis coding. Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials. Ability to perform on-line research and analyze data for conclusive thought. Physical Requirements Able to sit in a seated position for extended periods of time. Able to reach by extending hand(s) or arm(s) in any direction. Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.

Minimum Qualifications High School Diploma or graduation equivalent. Two years' experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.

Classified Title: AR Revenue Cycle Specialist II Role/Level/Range: ATO 40/E/02/OD Starting Salary Range: $16.00 - $28.50 HRLY ($46,280 targeted; Commensurate with experience) Employee group: Full Time Schedule: M-F 8:30-5:00 Exempt Status:Non-Exempt Location:Hybrid/JH at Middle River Department name: SOM DOM Billing Personnel area: School of Medicine

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