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AR Revenue Cycle Specialist

4 months ago

Middle River, United States Johns Hopkins University Full time

Job Req ID:

113335

AR Revenue Cycle Specialist

We are seeking a who will be responsible for the basic collection of unpaid third-party claims and standard appeals, using various JHM applications and JHU/ PBS billing applications. 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. Recognize and resolve incorrect demographic and insurance registration based on an understanding of the outpatient registration process. The Specialist 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.

Special Knowledge, Skills & Abilities

Ability to use various billing and patient information computer systems. Knowledge of various payer processing and submission guidelines.
Familiarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of medical billing applications.
Utilize online resources to facilitate efficient claims processing.
Knowledge of medical terminology, CPT codes and diagnosis coding.
Excellent interpersonal, communication and customer service skills required.

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.

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

Total Rewards
The referenced salary range is based on Johns Hopkins Universitys good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: .

Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.

**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.

The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.

The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.

Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

EEO is the Law: