We are seeking an AR Revenue Cycle Specialist II who will be 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 claims submission process, either electronically or by paper. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The Specialist 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.

• Drafts and resolves non-standard appeals.

• Performs claim edits.

• 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.

• 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 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.

Special Knowledge, Skills & Abilities

• Comprehensive knowledge and compliance of 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.

• 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.

• Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions.

• 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.

• 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: $16.20 - $28.80 HRLY ($45,000 targeted; Commensurate with experience)

Employee group: Full Time

Schedule: M-F 8a-430p

Exempt Status: Non-Exempt

Location: Hybrid/School of Medicine Campus

Department name: SOM PMR Production Unit Billing

Personnel area: School of Medicine

Equal Opportunity Employer:

Johns Hopkins University is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria. The university promotes affirmative action for minorities, women, disabled persons, and veterans.