• AR Revenue Cycle Specialist III

    Johns Hopkins University (Middle River, MD)


    We are seeking an **_AR Revenue Cycle Specialist III_** 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 claims 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 and 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.

    + 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.

    _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.

    + Three years' experience in a medical billing, insurance follow-up processing, or similar medical specialty environment. Significant experience and expertise using Epic Resolute for A/R functions and resolution of revenue cycle issues in an academic medicine environment, CPC and/or AHIMA certification preferred.

    Knowledge, Skills and 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.

     

    Classified Title: AR Revenue Cycle Specialist III

    Role/Level/Range: ATO 40/E/02/OE

    Starting Salary Range: $18.20 - $33.90 HRLY ($55,000 targeted; Commensurate w/exp.)

     

    Employee group: Full Time

     

    Schedule: M-F, 8:30am - 5:00pm

     

    FLSA Status: Non-Exempt

     

    Department name: ​​​​​​​SOM Rad Onc General Administration

    Personnel area: School of Medicine

    The listed salary range represents the minimum and maximum Johns Hopkins University offers for this position, based on a good faith estimate at the time of posting. Actual compensation will vary depending on factors such as location, skills, experience, market conditions, education, and internal equity. Not all candidates will qualify for the highest salary in the range.

     

    Johns Hopkins provides a comprehensive benefits package supporting health, career, and retirement. Learn more: https://hr.jhu.edu/benefits-worklife/.

     

    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

    https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf