Johns Hopkins University
AR Revenue Cycle Specialist (Pediatrics -SOM)
Johns Hopkins University, Baltimore, Maryland, United States, 21276
Overview
We are seeking an
AR Revenue Cycle Specialist
to 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 claim's 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
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 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 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 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 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. 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 may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. 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 AllQualified 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. 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 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. Seasonal flu vaccine is still required for all faculty, staff, and students. Exceptions may be provided for religious beliefs or medical reasons. The School of Medicine (SOM) requires full vaccination with an FDA COVID-19 vaccine and proof of vaccination status. More information for SOM and other applicants is available at the provided links. The following additional provisions may apply
depending on campus. The pre-employment physical for clinical or research positions requires documentation of immune status against several diseases and related vaccinations; vaccination costs may be covered by the Occupational Health office.
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We are seeking an
AR Revenue Cycle Specialist
to 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 claim's 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
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 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 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 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 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. 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 may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. 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 AllQualified 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. 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 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. Seasonal flu vaccine is still required for all faculty, staff, and students. Exceptions may be provided for religious beliefs or medical reasons. The School of Medicine (SOM) requires full vaccination with an FDA COVID-19 vaccine and proof of vaccination status. More information for SOM and other applicants is available at the provided links. The following additional provisions may apply
depending on campus. The pre-employment physical for clinical or research positions requires documentation of immune status against several diseases and related vaccinations; vaccination costs may be covered by the Occupational Health office.
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