The Johns Hopkins University
AR Revenue Cycle Specialist III - 118828
The Johns Hopkins University, Middle River, Maryland, United States, 21220
Overview
AR Revenue Cycle Specialist III — Johns Hopkins University (Requisition ID: 118828). Responsible for the collection of unpaid third-party claims and independent resolution of complex appeals, utilizing JHM and JHU/PBS billing applications. Conduct online research to resolve issues across sub-specialties and high-cost procedures. Incorporate research findings on medical policy into appeals documentation. Communicate with payers to resolve issues and facilitate prompt payment of claims. Communicate with providers regarding appeals and medical policy denials and provide proactive guidance for future practice. Review chart notes and interpret data for appropriate action. Follow up with insurance companies to collect outstanding accounts, and monitor denial trends for continuous improvement. Mentor junior specialists as appropriate. Responsibilities
Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal. Gathers and verifies information required to produce a clean claim, including payer-specific or contract-defined billing procedures. Prepares appeals documentation and incorporates results of medical policy research and interpretation. Resolves claim edits. Researches medical policies to resolve denials based on medical necessity. Researches and applies LCDs. Reviews and interprets chart notes. Resolves issues across sub-specialties and/or related to complex or high-cost procedures. Contacts providers regarding appeals and medical policy denials, identifies additional documentation needed, and provides guidance for future practice. Retrieves, reviews, and interprets supporting documents (medical reports, authorizations, etc.) and submits to third-party payers. Appeals reflected claims and low-reimbursement claims. Confirms credit balances and gathers documentation for processing refunds. Identifies insurance issues of primary vs. secondary insurance and coordination of benefits. Contacts payors or patients for corrective action to resolve issues and obtain payment. Monitors invoice activity until issues are resolved. Supports and mentors junior specialists; escalates issues as appropriate. Assesses denial trends and recommends proactive changes to the Production Unit Manager. Minimum Qualifications
High School Diploma or graduation equivalent. Three years of experience in medical billing, insurance follow-up processing, or a similar medical environment. Significant experience using Epic Resolute for A/R functions in an academic medicine setting. Additional education may substitute for required experience, and additional related experience may substitute for required education as permitted by the Johns Hopkins equivalency formula. Preferred Qualifications
CPC and/or AHIMA certification preferred. Classified Title: AR Revenue Cycle Specialist III Role/Level/Range: ATO 40/E/02/OE Starting Salary Range: $18.20 - $33.90 hourly ($55,000 targeted; commensurate with experience) Employee group: Full Time Schedule: M - F; 8:30am - 5:00pm FLSA Status: Non-Exempt Location: Hybrid/JH at Middle River Department: SOM DOM Production Unit Billing Education and Experience Equivalency and other required notices are described in the job description.
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AR Revenue Cycle Specialist III — Johns Hopkins University (Requisition ID: 118828). Responsible for the collection of unpaid third-party claims and independent resolution of complex appeals, utilizing JHM and JHU/PBS billing applications. Conduct online research to resolve issues across sub-specialties and high-cost procedures. Incorporate research findings on medical policy into appeals documentation. Communicate with payers to resolve issues and facilitate prompt payment of claims. Communicate with providers regarding appeals and medical policy denials and provide proactive guidance for future practice. Review chart notes and interpret data for appropriate action. Follow up with insurance companies to collect outstanding accounts, and monitor denial trends for continuous improvement. Mentor junior specialists as appropriate. Responsibilities
Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal. Gathers and verifies information required to produce a clean claim, including payer-specific or contract-defined billing procedures. Prepares appeals documentation and incorporates results of medical policy research and interpretation. Resolves claim edits. Researches medical policies to resolve denials based on medical necessity. Researches and applies LCDs. Reviews and interprets chart notes. Resolves issues across sub-specialties and/or related to complex or high-cost procedures. Contacts providers regarding appeals and medical policy denials, identifies additional documentation needed, and provides guidance for future practice. Retrieves, reviews, and interprets supporting documents (medical reports, authorizations, etc.) and submits to third-party payers. Appeals reflected claims and low-reimbursement claims. Confirms credit balances and gathers documentation for processing refunds. Identifies insurance issues of primary vs. secondary insurance and coordination of benefits. Contacts payors or patients for corrective action to resolve issues and obtain payment. Monitors invoice activity until issues are resolved. Supports and mentors junior specialists; escalates issues as appropriate. Assesses denial trends and recommends proactive changes to the Production Unit Manager. Minimum Qualifications
High School Diploma or graduation equivalent. Three years of experience in medical billing, insurance follow-up processing, or a similar medical environment. Significant experience using Epic Resolute for A/R functions in an academic medicine setting. Additional education may substitute for required experience, and additional related experience may substitute for required education as permitted by the Johns Hopkins equivalency formula. Preferred Qualifications
CPC and/or AHIMA certification preferred. Classified Title: AR Revenue Cycle Specialist III Role/Level/Range: ATO 40/E/02/OE Starting Salary Range: $18.20 - $33.90 hourly ($55,000 targeted; commensurate with experience) Employee group: Full Time Schedule: M - F; 8:30am - 5:00pm FLSA Status: Non-Exempt Location: Hybrid/JH at Middle River Department: SOM DOM Production Unit Billing Education and Experience Equivalency and other required notices are described in the job description.
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