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AR Revenue Cycle Specialist II (Baltimore, MD, United States, 21220) en Johns Hopkins University

Johns Hopkins University · Baltimore, Estados Unidos De América · Remote

33.696,00 US$  -  59.904,00 US$

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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 
Location: Remote 
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.

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