Insurance Resolution Specialist
We are seeking an Insurance Resolution Specialist (remote position) who will be responsible for Johns Hopkins Medicine Epic registration and Epic professional billing system duties with a focus on resolution of patient insurance discrepancies. Patient registration information [demographic, guarantor, and coverage] is shared by all Johns Hopkins Health System (JHHS) Hospitals, Johns Hopkins Community Physicians (JHCP) and the School of Medicine patient services locations. The complexities of the patient registration combined with clinical, and payer requirements require staff that are medical insurance subject matter experts and highly knowledgeable with the various insurance payers and clinical specialties. Candidate must also be system savvy, analytical, and highly detail oriented. Must work well under pressure, effectively and efficiently use all internal and external technology and applications relevant to researching, analyzing, and resolving registration errors, while maintaining productivity and quality standards. Staff is expected to make outbound calls to patients, payers, or the Office of Managed Care and collaborate with production unit, customer service and/or self-pay staff to correct a patient’s account fully and accurately. In this role of subject matter expert, staff is expected to communicate with the production units/departments, customer service staff, and others requiring assistance in correcting a patient’s registration record.
Specific Duties & Responsibilities
- To resolve patient insurance related issues across the continuum of the life of a charge, from prior to the patient visit to after the charge was received by the payer and denied.
- To register and verify patients, as needed.
- Responsible for resolving fatal edits for which the claim was prevented from being successfully received by the clearinghouse.
- Applies analytical skills to assess rejection scenarios and applies best practice workflows to accurately work the account.
- Responsible for accurately investigating eligibility issues with a patient’s account for which the claim was denied by the payer.
- Effectively utilizes all systems and resources available to resolve patient registration issues and ensures the correct coverage is added to the patient account.
- Effectively manages workload to meet the unit’s goals and individual productivity and quality standards.
- Corrects all accessible systems with correct insurance information to minimize system overrides from source systems so future claims are processed efficiently, expediting revenue recovery by preventing future rejections.
- Collaborates and communicates with patients, and other internal or external stakeholders, i.e. production unit staff, or other core unit staff, payers or the office of managed care to resolve high level registration issues quickly and accurately.
- Accurately and comprehensively documents activities including root cause/why codes.
- Provides subject matter expert support to staff in other core units or to super users in production units.
- Recognizes potential error patterns and trends, which may warrant further investigation and informs leads or unit manager discovery.
- Communicates payer specific, department or user issues identified during the investigative process to leads.
- Exhibits a comprehensive knowledge of regulatory compliance and HIPAA rules, regulations in the dissemination of patient Protected Health Information (PHI).
- Files/Refiles invoices to the correct insurance company.
Knowledge, Skills & Abilities
- Expert knowledge of Payer and Plans, and clinical specialty requirements as they relate to patient registration
- Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
- Efficiency in SOM billing application, Epic registration application, as well as other relevant application such and OnBase, or the Hopkins Electronic Medical Record.
- Utilize online resources to facilitate efficient claims processing.
- Proficient in Excel.
- Participates in on-going educational activities.
- Assists in the training of staff.
- Keeps on work related topics.
- Completes three days of training annually.
- Must be able to complete all relevant system training and acquire proficiency Epic Prelude (patient registration function) and PB Resolute (professional billing application).
- Must attend and meet all requirements related to insurance training.
- Has a basic understanding of front-end registration and back-end workflows and can identify patterns that may require intervention and further investigation by leads or manager.
- Has a full understanding of the professional fee billing process.
- Understand and follow JHU and supporting departmental policies and procedures.
Service Excellence
- Must adhere to Service Excellence Standards.
- Customer Relations.
- Self-Management.
- Teamwork.
- Communication.
- Ownership/Accountability.
- Continuous Performance Improvement.
Minimum Qualifications
- High School diploma or graduation equivalent.
- Two years of experience in medical billing, front end/back-end operations or a similar environment.
- Additional education may substitute for required experience and additional related experience may substitute for required education, to the extent permitted by the JHU equivalency formula.
Preferred Qualifications
- Knowledge of CPT, ICD, Medical Terminology.
- Knowledge of Epic.
Classified Title: Insurance Resolution Specialist
Role/Level/Range: ATO 37.5/02/OD
Starting Salary Range: $16.20 - $28.80 HRLY ($43,000 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Flexible shifts
FLSA Status: Non-Exempt
Location: Remote
Department name: SOM Admin CPA Quality Assurance
Personnel area: School of Medicine