CO Collection Specialist
We are seeking a CO Collections Specialist who will be 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 claim's 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
Procedural Knowledge
- 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.
Technical Knowledge
- 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.
Service Excellence
- Must adhere to Service Excellence Standards.
- Customer Relations
- Self-Management
- Teamwork
- Communications
- Ownership/Accountability
- Continuous Performance Improvement
Minimum Qualifications
- HS/GED required.
- One year experience in a medical billing or similar medical specialty environment required.
- 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.
Minimum Skills & Abilities
- Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
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.
- Able to communicate using the spoken and written word.
- Able to see within normal parameters and to hear within normal range.
- Able to move about.
- Able to lift minimum weight, 10 lbs.
Classified Title: Collection Specialist
Job Posting Title (Working Title): CO Collection Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: Min $15.50 - Max $25.00 HRLY ($40,000 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: Mon - Fri 8:30 am - 5:00 pm
Exempt Status: Non-Exempt
Location: MD - Other Location
Department name: 10003407-SOM OB GYN Production Unit Billing
Personnel area: School of Medicine