AR Revenue Cycle Specialist II
We are seeking an AR revenue Cycle Specialist II who will be 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 claim's 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 & 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.
Minimum Qualifications
- High School Diploma or graduation equivalent.
- Two years experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
Classified Title: AR Revenue Cycle Specialist II
Job Posting Title (Working Title): AR Revenue Cycle Specialist II
Role/Level/Range: ATO 40/E/02/OD
Starting Salary Range: $16.20 - $28.80 HRLY (Commensurate with experience)
Employee group: Full Time
Schedule: Monday-Friday, 8:30 am - 5:00 pm
Exempt Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Oph Production Unit Billing
Personnel area: School of Medicine