Responsible for the collection of unpaid third-party claims and appeals, using various applications of JHM and JHU/ PBS billing applications. Works with the 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 claims submission process, either electronically or by paper. Experience in Radiation Oncology billing preferred. The Specialist will be assigned payor groups of outstanding patient accounts. Various methods of follow-up will be used including all JHU/ PBS Billing Applications. The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the JHOC registration process and be able to recognize and resolve incorrect demographic and insurance registration. The Specialist must have an understanding of claims submission requirements for all payors to expedite payments as well as knowledge of appeals and rejections processing..
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.
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 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.
Process daily mail, edits reports, file or pull EOB batches.
Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of JHU/ PBS Billing Applications.
Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development:
Participate in on-going educational activities.
Assist in the training of staff.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.
Must adhere to Service Excellence Standards.
o Customer Relations
o Continuous Performance Improvement
Minimum Qualifications (Required)
High School Diploma or GED required.
One (1) year experience in a medical billing or similar specialty environment
Knowledge of medical terminology, CPT codes and diagnosis coding
Excellent interpersonal, communication and customer service skills
Additional education may be substituted for up to one year of experience.JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
Ability to use various billing and patient information computer systems preferred.
Knowledge of various payer processing and submission guidelines preferred.
Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.
Classified Title: Collection Specialist Working Title: CO Collection Specialist Role/Level/Range: ATO 40/E/02/OC Starting Hourly Pay Rate Range: $13.36 - $18.41 /Commensurate with Experience Employee group: Full Time Schedule: 8:00AM - 4:30PM/ 40 hrs per week Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10003283-SOM Rad Onc General Administration Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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 HR Business Services Office at firstname.lastname@example.org. For TTY users, call via Maryland Relay or dial 711.
The following additional provisions may apply depending on which campus you will work. Your recruiter will advise accordingly.
During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.
The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.
Equal Opportunity Employer Note: Job Postings are updated daily and remain online until filled.
Johns Hopkins University remains committed to its founding principle, that education for all students should be grounded in exploration and discovery. Hopkins students are challenged not just to learn but also to advance learning itself. Critical thinking, problem solving, creativity, and entrepreneurship are all encouraged and nourished in this unique educational environment. After more than 130 years, Johns Hopkins remains a world leader in both teaching and research. Faculty members and their research colleagues at the university's Applied Physics Laboratory have each year since 1979 won Johns Hopkins more federal research and development funding than any other university. The university has nine academic divisions and campuses throughout the Baltimore-Washington area. The Krieger School of Arts and Sciences, the Whiting School of Engineering, the School of Education and the Carey Business School are based at the Homewood campus in northern Baltimore. The schools of Medicine, Public Health, and Nursing share a campus in east Baltimore with The Johns Hopkins Hospital. The Peabody Institute, a leading professional school of music, is located on Mount Vernon Place in downtown Bal...timore. The Paul H. Nitze School of Advanced International Studies is located in Washington's Dupont Circle area.