AR Revenue Cycle Specialist II

2 days ago

Baltimore, Maryland, United States InsideHigherEd Full time
Job Summary

We are seeking a highly skilled AR Revenue Cycle Specialist II to join our team. As a key member of our revenue cycle operations team, you will be responsible for the collection of unpaid third-party claims and resolution of non-standard appeals. You will utilize various JHM applications and JHU/PBS billing applications to conduct on-line research, locate information, and resolve issues across different sub-specialties and/or relating to high-cost procedures.

Key Responsibilities
  • Use A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
  • Gather and verify all information required to produce a clean claim, including special billing procedures defined by a payer or contract.
  • Review and update patient registration information as needed.
  • Resolve claim edits and draft non-standard appeals.
  • Research medical policies to resolve denials based on medical necessity.
  • Apply LCDs and resolve issues across different sub-specialties and/or related to specialized, complex, or high-cost procedures.
  • Apply appropriate discounts/courtesies based on department policy.
  • Prepare delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
  • Print and mail claim forms and statements according to the follow-up matrix.
  • Retrieve supporting documents as needed and submit to third-party payers.
  • Appeal rejected claims and claims with low reimbursement.
  • Confirm credit balances and gather necessary documentation for processing refund.
  • Identify insurance issues of primary vs. secondary insurance, coordination of benefits eligibility, and any other issue causing non-payment of claims.
  • Contact payors or patients as appropriate for corrective action to resolve the issue and receive payment of claims.
  • Monitor invoice activity until the problem is resolved.
  • Advise junior specialists as appropriate, confirm, and assume responsibility for escalated issues.
  • Identify and inform the supervisor/Production Unit Manager of issues or problems associated with non-payment of claims and non-standard appeals.
Requirements
  • High School Diploma or graduation equivalent.
  • Two years of experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
Working Conditions
  • 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.

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