We are seeking an AR Revenue Cycle Specialist II responsible for the collection of unpaid third-party claims and resolution of non-standard 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. Communicates 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 claims 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. The Specialist will research and interpret medical policies regarding denials based on medical necessity. Will use a working knowledge of local coverage determinations (LCD?s) to research and apply appropriately. Will mentor and advise junior specialists as appropriate.

Specific Duties and 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 LCD?s.
• 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.
• Monitor 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.

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.

• High School Diploma or graduation equivalent.
• Two years' experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
• Additional education may substitute for required experience to the extent permitted by the JHU equivalency formula.

Classified Title: AR Revenue Cycle Specialist II 
Role/Level/Range: ATO 40/E/02/OC  
Starting Salary Range: $15.70 - $25.25 HRLY ($46,800 targeted; Commensurate w/exp.) 
Employee group: Full Time 
Schedule: M-F 8:30-5:00 
FLSA Status: Non-Exempt 
Location: Hybrid/JH at Middle River 
Department name: ???????SOM DOM Billing  
Personnel area: School of Medicine 

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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