We are seeking a Enrollment & Reimbursement Coordinator - Lead Specialist who will provide on-going training and support to Enrollment Reimbursement Coordinators, physicians, and non-physician providers and other personnel on provider enrollment and credentialing requirements. Works in close collaboration with the clinical departments, Physicians Billing Service, and the Johns Hopkins Central Credentialing Office. Prepares reports for the Director of Provider Enrollment, Provider Enrollment Manager and clinical departments regarding the status of providers payor enrollments. This position serves as a lead enrollment coordinator for Government enrollment.

Specific Duties & Responsibilities

Lead Specialist Responsibilities (50%)

• Serves as team lead responsible for reviewing and analyzing the accuracy of staff work related to government payor enrollments.
• Conducts independent reviews/audits on the adequacy of government payor enrollments.
• Ensure staff enroll/reenroll all active providers prior to their projected start/revalidation dates.
• Assists manager and enrollment coordinators in developing corrective action plans to improve.
• Serves as a resource for staff questions.
• Assist in training new staff and existing staff members.
• Provide feedback regarding problems to Provider Enrollment Manager and assists in problem resolution,
• Generate weekly and monthly productivity reports.
• Originates ad hoc data reports and summarizes results.
• Audits payer websites for erroneous or missing provider profile data.
• Audits SER information and updates provider dictionaries effectively.

Provider Enrollment Responsibilities (50%)

• Enrolls School of Medicine CPA Faculty and ancillary support staff with government payers timely and accurately.
• Follows Medicare PECOS Provider Enrollment Policy and escalates cases when providers have not responded within specified timeframe.
• Reviews and resolves provider enrollment related rejections dailyReviews Provider Enrollment Charge Edits timely to identify and enroll providers who need to be enrolled with government payors.
• Reviews Provider Enrollment related Claim Edits timely to ensure providers with outstanding enrollments are captured and resolved quickly.
• Ensures Epic SER records, NPPES, ePREP, and all other government payor databases are updated with providers most current billing related information timely and accurately.
• Communicates with the Enrollment Manager regarding enrollment applications that are returned to identify issues and cases for appeal.
• Investigates enrollment impacted third party claims rejections and patient referral denials.
• Third party liaison between production units and insurance networks.
• Coordinates all aspects of JHU-CPA individual provider participation with health insurance carriers under their respective delegated credentialing agreements.
• Assures information obtained and transmitted on providers is accurate and timely, to maximize potential revenue through validated participation in payers and JHUs respective IS-systems.
• Monitors and/or maintains process by which providers are recognized and enrolled with payers and satisfactorily set-up in Epic.
• Oversees data integrity in the Epic billing system provider dictionary for key billing provider identities.
• Serves as principal liaison to JHM hospitals respective Medical Staff Offices and the JHM CCO to address status changes, location, corresponding impact on billing procedures, etc...
• Resolve disputes, discrepancies and other provider enrollment related problems, as necessary.

Special Knowledge, Skills & Abilities

• Proficient in use of Excel.
• Excellent organizational skills.
• Strong analytical/problem solving skills required.
• Excellent oral and written communications skills required.
• Ability to interact with all levels of staff.

Physical Requirements 

• Able to sit in a normal seated position for extended periods of time.
• Able to reach by extending hand(s) or arm(s) in any direction.
• Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.

• Bachelors Degree required.
  
• Two year's experience in a specialty billing area or previous medical billing experience in similar environment is required.
• Professional credentialing for commercial and governmental health plans experience required.
• Additional education may substitute for required experience and additional experience may substitute for required education, to the extent permitted by the JHU equivalency formula.

• Knowledge of the Epic billing system preferred.
  

Classified Title: Enrollment & Reimbursement Coordinator 
Working Title: Enrollment & Reimbursement Coordinator, Lead Specialist   
Role/Level/Range: ATO 40/E/02/OE  
Starting Salary Range: $17.95-$25.30-$32.60 HRLY (Commensurate with experience) 
Employee group: Full Time 
Schedule: Monday-Friday 8:30am-5pm 
Exempt Status: Non-Exempt 
Location: Hybrid/JH at Middle River 
Department name: SOM Admin CPA Contract Services  
Personnel area: School of Medicine 

Total Rewards
The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/

Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines:

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.

**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.

The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.

The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.

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
Learn more:
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf

Accommodation Information

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 Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit accessibility.jhu.edu.

Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.

The following additional provisions may apply, depending on campus. Your recruiter will advise accordingly.

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.

Note: Job Postings are updated daily and remain online until filled.

About Johns Hopkins University

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.

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