Inside Higher Ed
AR Revenue Cycle Specialist (Pathology)
Inside Higher Ed, Baltimore, Maryland, United States, 21276
AR Revenue Cycle Specialist (Pathology)
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The Pathology Department is 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 elevate to a more senior specialist.
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.
Reviews and updates 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 the 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.
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 a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.
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.
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The Pathology Department is 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 elevate to a more senior specialist.
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.
Reviews and updates 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 the 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.
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 a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.
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.
#J-18808-Ljbffr