Johns Hopkins University
AR Revenue Cycle Specialist II
Johns Hopkins University, Middle River, Maryland, United States, 21220
AR Revenue Cycle Specialist II
We are seeking an
AR Revenue Cycle Specialist II
who will be responsible for the collection of unpaid third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/PBS billing applications. The Specialist will conduct online research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures, communicate 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. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. Research and interpret medical policies regarding denials based on medical necessity, use a working knowledge of local coverage determinations (LCDs) to research and apply appropriately, and mentor and advise junior specialists as appropriate.
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.
Drafts and resolves non-standard appeals.
Researches medical policies to resolve denials based on medical necessity.
Researches and applies LCDs.
Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
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.
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.
Monitors invoice activity until problem is resolved.
Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non‑payment of claims and non‑standard appeals.
Minimum Qualifications
High School Diploma or graduation equivalent.
Two years experience in a medical billing, insurance follow‑up processing, or similar medical specialty environment.
Classified Title: AR Revenue Cycle Specialist II
Job Posting Title (Working Title): AR Revenue Cycle Specialist II
Role/Level/Range: ATO 40/E/02/OD
Starting Salary Range: $16.20 - $28.80 HRLY (Commensurate with experience)
Employee group: Full Time
Schedule: Monday-Friday, 8:30 am - 5:00 pm
Exempt Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Oph Production Unit Billing
Personnel area: School of Medicine
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AR Revenue Cycle Specialist II
who will be responsible for the collection of unpaid third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/PBS billing applications. The Specialist will conduct online research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures, communicate 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. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. Research and interpret medical policies regarding denials based on medical necessity, use a working knowledge of local coverage determinations (LCDs) to research and apply appropriately, and mentor and advise junior specialists as appropriate.
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.
Drafts and resolves non-standard appeals.
Researches medical policies to resolve denials based on medical necessity.
Researches and applies LCDs.
Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
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.
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.
Monitors invoice activity until problem is resolved.
Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non‑payment of claims and non‑standard appeals.
Minimum Qualifications
High School Diploma or graduation equivalent.
Two years experience in a medical billing, insurance follow‑up processing, or similar medical specialty environment.
Classified Title: AR Revenue Cycle Specialist II
Job Posting Title (Working Title): AR Revenue Cycle Specialist II
Role/Level/Range: ATO 40/E/02/OD
Starting Salary Range: $16.20 - $28.80 HRLY (Commensurate with experience)
Employee group: Full Time
Schedule: Monday-Friday, 8:30 am - 5:00 pm
Exempt Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Oph Production Unit Billing
Personnel area: School of Medicine
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