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CO Collection Specialist

1 month ago

Middle River, United States Johns Hopkins University Full time

The Pathology Department is seeking a Collection Specialist who will be responsible for the collection of unpaid third-party claims and appeals, using various applications of JHM and JHU/ PBS billing applications. Works with the 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 claims submission process, either electronically or by paper. The Specialist will be assigned payor groups of outstanding patient accounts. Various methods of follow-up will be used including all JHU/ PBS Billing Applications. The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the JHOC registration process and be able to recognize and resolve incorrect demographic and insurance registration. The Specialist must have an understanding of claims submission requirements for all payors to expedite payments as well as knowledge of appeals and rejections processing. This position requires excellent communication skills coupled with patience and fortitude.

Specific Duties & Responsibilities

Procedural Knowledge

  • 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.
  • 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 reflected claims and claims with low reimbursement.
  • Confirms 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 payor or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
  • Monitors invoice activity until problem is resolved.
  • Processes daily mail, edits reports, files or pulls EOB batches.
  • Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
  • Utilizes online resources to facilitate efficient claims processing.
  • Performs miscellaneous related duties as assigned.

Department Specific Responsibilities

  • Performs assigned duties as listed in this job description for the Department of Pathology which may include but is not limited Johns Hopkins Medical Laboratories, Green Spring Station and other outreach Laboratories, Johns Hopkins Reference Laboratories, Professional Fee Billing, and other areas as assigned (ex: IVF Lab at Greenspring, Genetics DNA Lab, Dermapathology).

Professional and Personal Development

  • Participate in on-going educational activities.
  • Assist in the training of staff.
  • 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

Special Knowledge, Skills, & Abilities

  • Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
  • Working knowledge of JHU/ PBS Billing Applications.
  • Knowledge of various payer processing and submission guidelines.
  • Excellent interpersonal, communication and customer service skills.

Specific Physical Requirements

  • Able to sit in a normal 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.
  • Able to communicate using the spoken and written word.
  • Able to see within normal parameters and to hear within normal range.
  • Able to move about.
  • Able to lift minimum weight, 10 lbs.
Minimum Qualifications
  • High school graduation/GED.
  • One year experience in a medical billing or similar medical specialty environment.
  • Knowledge of medical terminology, CPT codes and diagnosis coding.
  • Additional education may substitute for required experience to the extent permitted by the JHU equivalency formula.
Preferred Qualifications
  • IDX and EPIC experience.
  • Experience with various billing and patient information computer systems.

Classified Title: Collection Specialist
Job Posting Title (Working Title):CO Collection Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.50 - $25.00 HRLY ($42,000 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F, 8:30am-5:00pm
Exempt Status:Non-Exempt
Location:Hybrid/School of Medicine Campus
Department name: SOM Pat Production Unit Billing
Personnel area: School of Medicine