• AR Revenue Cycle Specialist II - #Staff

    Johns Hopkins University (Baltimore, MD)


    We are seeking a **_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 and 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.

    + Drafts and resolves non-standard appeals.

    + Researches 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.

    + 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.

    _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.

    + Two years of experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.

    + Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.

     

    Classified Title: AR Revenue Cycle Specialist II

     

    Job Posting Title (Working Title): AR Revenue Cycle Specialist II

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

    Starting Salary Range: $16.20 - $28.80 HRLY ($22.50/hour targeted; Commensurate w/exp.)

     

    Employee group: Full Time

     

    Schedule: Mon - Fri / 8am - 4:30p

     

    FLSA Status: Non-Exempt

     

    Department name: 10002950-SOM Onc Oncology Professional Fees

     

    Personnel area: School of Medicine

     

    This salary range does not include all components of the SOM/Oncology compensation program. This position may be eligible for a discretionary bonus. Therefore, the actual compensation paid to the selected candidate may vary slightly from the salary range stated herein. For more information, please contact the hiring department.

     

    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