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. 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 understand 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. This position requires excellent communication skills coupled with patience and fortitude.
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 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.
Works assigned mail correspondence.
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.
Keep current of industry changes by reading assigned material on work related topics.
Assist in the training of staff when requested.
Complete three days of training annually.
Department Specific Responsibilities:
To be able to work in a remote work environment while maintaining protected PHI guidelines.
To be able to meet departmental production expectations.
Have the ability to multi-task.
To incorporate strong problem-solving skills.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
Minimum Qualifications (Required)
One (1) year experience in a medical billing or similar medical specialty environment.
Knowledge of medical terminology, CPT codes and diagnosis coding required.
Excellent interpersonal, communication and customer service skills required.
Ability to use various billing and patient information computer systems preferred.
Knowledge of various payer processing and submission guidelines preferred.
Additional education minimum experience qualifications may substitute for required experience to the extent permitted by the JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. 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.
Special Knowledge, Skills, and Abilities
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc..
Classified Title: Collection Specialist Working Title: CO Collection Specialist Role/Level/Range: ATO 40/E/02/OC Starting Salary Range: $17.42 - $23.95/ Commensurate with Experience Employee group: Full Time Schedule: Monday - Friday, 8:30 am - 5:00 pm / 40 hrs per week Exempt Status: Non-Exempt Location: 20-MD:JH at Franklin Square Middle River, MD Department name: 10003407-SOM OB GYN Production Unit Billing Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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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.
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