We are seeking a PB AR Revenue Cycle Specialist 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 & 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

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.

Physical Requirements

• Able to sit in a seated position for extended periods of time.

• Able to reach by extending hand(s) or arm(s) in any direction.

• Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.

Minimum Qualifications

• High School Diploma or graduation equivalent.

• One year experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.

Classified Title: AR Revenue Cycle Specialist

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

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

Starting Salary Range: $15.50 - $25.00 HRLY ($42,230 targeted; Commensurate with experience)

Employee group: Full Time

Schedule: M-F: 40hrs/wk

Exempt Status: Non-Exempt

Location: Hybrid/JH at Middle River

Department name: ​​​​​​​SOM DOM 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.