We are seeking an AR Revenue Cycle Specialist III who will be responsible for the collection of unpaid third-party claims and independent resolution of complex appeals, using various JHM applications and JHU/ PBS billing applications. Will conduct on-line research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive guidance for future practice. Review chart notes and interpret data for appropriate conclusive action. Follow-up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process, either electronically or by paper. Will monitor and identify trends in denials and recommend systematic proactive changes for continuous improvement. Will mentor and advise junior specialists as appropriate.
Specific Duties and Responsibilities
Procedural Knowledge
- 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.
- 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 LCD’s.
- Reviews and interprets chart notes.
- Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
- Contacts providers regarding appeals and medical policy denials, identifies and collects additional documentation needed and provides appropriate guidance for future practice.
- Retrieves, reviews and interprets supporting documents (medical reports, authorizations, etc) as needed and submits to third-party payers.
- Appeals reflected 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.
- Monitor invoice activity until problem is resolved.
- Assists and mentors junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
- Recommend proactive changes based on analysis of denial trends to the / Production Unit Manager.
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 & Abilities
- Ability to use various billing and patient information computer systems.
- Knowledge of various payer processing and submission guidelines.
- Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions.
- Comprehensive knowledge of and compliance with HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
- Comprehensive knowledge of medical billing applications.
- Utilize online resources to research policy and regulations to facilitate efficient claims processing.
- Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures.
- Excellent interpersonal, communication and customer service skills required.
- Ability to review and interpret chart notes.
- Knowledge of medical terminology, CPT codes and diagnosis coding.
- Ability to perform on-line research and analyze data for conclusive thought.
- Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials.
Minimum Qualifications
- High School Diploma or graduation equivalent.
- Three years experience in a medical billing, insurance follow-up processing, or similar medical specialty environment required.
- Significant experience and expertise using Epic Resolute for A/R functions and resolution of revenue cycle issues in an academic medicine 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.
Preferred Qualifications
- CPC and/or AHIMA certification preferred.
Classified Title: AR Revenue Cycle Specialist III
Job Posting Title (Working Title): AR Revenue Cycle Specialist III
Role/Level/Range: ATO 40/E/02/OE
Starting Salary Range: $18.20 - $33.90 HRLY ($26.00/hr. targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Monday – Friday, 8:30 A.M – 5:00 P.M.
FLSA Status: Non-Exempt
Location: Remote
Department name: 10003413-SOM Uro Production Unit Billing
Personnel area: School of Medicine
This salary range does not include all components of the Urology Production Unit Billing within the School of Medicine compensation program. This position may be eligible for a discretionary bonus. Therefore, the actual compensation paid to the selected candidate may vary slightly from the salary range stated herein. For more information, please contact the hiring department.
