AR Revenue Cycle Specialist

Johns Hopkins University; Baltimore (MD); Hybrid; Full time

Job summary

Johns Hopkins University seeks an AR Revenue Cycle Specialist to manage unpaid third-party claims and standard appeals. The Specialist will facilitate timely payments by communicating with payers and ensuring compliance with claims submission requirements. The role involves extensive interaction with patients and insurers, necessitating strong communication and customer service skills. This full-time position offers a competitive salary and the opportunity for professional development in a dynamic healthcare environment.

Qualifications

• One year of experience in medical billing or insurance follow-up.
• Ability to use various billing and patient information systems.

Responsibilities

• Responsible for the collection of unpaid third-party claims.
• Follow-up with insurance companies to resolve claims issues.
• Review and update patient registration information as needed.

Skills

Interpersonal skills

Communication skills

Customer service skills

Education

High school diploma or equivalent

Tools

Billing and patient information systems

Job description

We are seeking an AR Revenue Cycle Specialist responsible for the basic collection of unpaid third-party claims and standard appeals, using various JHM applications and JHU/ PBS billing applications. 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. Recognize and resolve incorrect demographic and insurance registration based on an understanding of the outpatient registration process. The Specialist will use an understanding of claims submission requirements for payors in order to expedite payments, and possess a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior specialist.

Principal Duties and 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.
• Resolves claim edits 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 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.
• Performs claim edits as needed.
• 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.
• Process daily mail, edits reports, file or pull EOB batches.
• Identifies and escalates non-standard appeals to a higher-level specialist.
• Informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.

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

Knowledge, Skills and Abilities

• Ability to use various billing and patient information computer systems.
• Knowledge of various payer processing and submission guidelines.
• Familiarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Working knowledge of medical billing applications.
• Utilize online resources to facilitate efficient claims processing.
• Knowledge of medical terminology, CPT codes and diagnosis coding.
• Excellent interpersonal, communication and customer service skills required.

Minimum Qualifications

• High school diploma or graduation equivalent.
• One year of experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
• Additional education may substitute for required experience and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.

Classified Title: AR Revenue Cycle Specialist
Role/Level/Range: ATO 40/E/02/OC
Starting Salary Range: $15.70 - $25.25 HRLY ($42,640 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

Total Rewards
The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education/training and other qualifications. 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/.

Education and Experience Equivalency
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 Completing Studies
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.

Background Checks
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.

Diversity and Inclusion
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
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.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 [e-mail]. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https://accessibility.jhu.edu/.

Vaccine Requirements
Johns Hopkins University strongly encourages, but no longer requires, at least one dose of the COVID-19 vaccine. The COVID-19 vaccine does not apply to positions located in the State of Florida. We still require all faculty, staff, and students to receive the seasonal flu vaccine. 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. This change does not apply to the School of Medicine (SOM). SOM hires must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of vaccination status. 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 upon 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.