Inside Higher Ed
AR Revenue Cycle Specialist (Pediatrics -SOM)
Inside Higher Ed, Baltimore, Maryland, United States, 21276
AR Revenue Cycle Specialist (Pediatrics -SOM)
AR Revenue Cycle Specialist (Pediatrics -SOM) role at Inside Higher Ed.
Responsibilities
Uses accounts receivable follow-up systems and reports to identify unpaid claims for collection/appeal.
Gathers and verifies information required to produce a clean claim, including special billing procedures 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.
Confirms credit balances and gathers necessary documentation for processing refunds.
Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
Contacts payors or patients as appropriate for corrective action to resolve the issue and receive payment of claims.
Monitors invoice activity until the problem is resolved.
Processes daily mail, edits reports, files or pulls 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.
Knowledge, Skills And Abilities
Ability to use various billing and patient information computer systems.
Knowledge of payer processing and submission guidelines.
Familiarity with HIPAA rules and regulations in the dissemination of 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.
Minimum Qualifications
High School Diploma or graduation equivalent.
One year of experience in medical billing, insurance follow-up processing, or a similar medical specialty environment.
Additional education may substitute for required experience and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.
Classified Title: AR Revenue Cycle Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.70 - $25.25 HRLY ($48,000 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: 7:00A-3:30P
FLSA Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Ped Production Unit Billing
Personnel area: School of Medicine
Total Rewards
The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education/training and other qualifications. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/.
Education and Experience Equivalency
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
Applicants Completing Studies
Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
Background Checks
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
Diversity and Inclusion
The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.
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
Accommodation Information
If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https://accessibility.jhu.edu/.
Vaccine Requirements
Johns Hopkins University strongly encourages, but no longer requires, at least one dose of the COVID-19 vaccine. The COVID-19 vaccine does not apply to positions located in the State of Florida. We still require all faculty, staff, and students to receive the seasonal flu vaccine. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry.
This change does not apply to the School of Medicine (SOM). SOM hires must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of vaccination status.
For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.
The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella, Rubeola, Mumps, Varicella, Hepatitis B and documentation of having received the Tdap vaccination. This may include documentation of having two MMR vaccines; two Varicella vaccines; or antibody status. Vaccinations will be provided at no cost in our Occupational Health office.
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Responsibilities
Uses accounts receivable follow-up systems and reports to identify unpaid claims for collection/appeal.
Gathers and verifies information required to produce a clean claim, including special billing procedures 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.
Confirms credit balances and gathers necessary documentation for processing refunds.
Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
Contacts payors or patients as appropriate for corrective action to resolve the issue and receive payment of claims.
Monitors invoice activity until the problem is resolved.
Processes daily mail, edits reports, files or pulls 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.
Knowledge, Skills And Abilities
Ability to use various billing and patient information computer systems.
Knowledge of payer processing and submission guidelines.
Familiarity with HIPAA rules and regulations in the dissemination of 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.
Minimum Qualifications
High School Diploma or graduation equivalent.
One year of experience in medical billing, insurance follow-up processing, or a similar medical specialty environment.
Additional education may substitute for required experience and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.
Classified Title: AR Revenue Cycle Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.70 - $25.25 HRLY ($48,000 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: 7:00A-3:30P
FLSA Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Ped Production Unit Billing
Personnel area: School of Medicine
Total Rewards
The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education/training and other qualifications. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/.
Education and Experience Equivalency
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
Applicants Completing Studies
Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
Background Checks
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
Diversity and Inclusion
The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.
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
Accommodation Information
If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https://accessibility.jhu.edu/.
Vaccine Requirements
Johns Hopkins University strongly encourages, but no longer requires, at least one dose of the COVID-19 vaccine. The COVID-19 vaccine does not apply to positions located in the State of Florida. We still require all faculty, staff, and students to receive the seasonal flu vaccine. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry.
This change does not apply to the School of Medicine (SOM). SOM hires must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of vaccination status.
For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.
The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella, Rubeola, Mumps, Varicella, Hepatitis B and documentation of having received the Tdap vaccination. This may include documentation of having two MMR vaccines; two Varicella vaccines; or antibody status. Vaccinations will be provided at no cost in our Occupational Health office.
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