AR Revenue Cycle Specialist III

The Johns Hopkins University; Baltimore (MD); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled AR Revenue Cycle Specialist III to manage the collection of unpaid claims and resolve complex appeals. This role involves utilizing various billing applications, conducting thorough research on medical policies, and communicating effectively with payers and providers. The ideal candidate will possess strong knowledge of medical billing, excellent interpersonal skills, and a commitment to continuous improvement. Join a dynamic team dedicated to enhancing revenue cycle processes and ensuring timely payments in a supportive environment that values professional development.

Qualifications

• 3+ years in medical billing or insurance follow-up processing.
• Experience with Epic Resolute for A/R functions.
• Knowledge of payer processing guidelines.

Responsibilities

• Collect unpaid third-party claims and resolve complex appeals.
• Conduct online research to resolve issues across specialties.
• Mentor junior specialists and recommend proactive changes.

Skills

Medical Billing Knowledge

Claims Resolution

HIPAA Compliance

Interpersonal Skills

Data Analysis

Medical Terminology

Education

High School Diploma

CPC Certification

Tools

Epic Resolute

Billing Systems

Job description

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We are seeking an AR Revenue Cycle Specialist III who will be responsible for the collection of unpaid third-party claims and independent resolution of complex 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. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive guidance for future practice. Review chart notes and interpret data for appropriate conclusive action. 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. Will monitor and identify trends in denials and recommend systematic proactive changes for continuous improvement. Will mentor and advise junior specialists as appropriate.

Specific 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.
• Prepares appeals documentation and incorporates results of medical policy research and interpretation.
• Resolves claim edits.
• Researches medical policies to resolve denials based on medical necessity.
• Researches and applies LCD’s.
• Reviews and interprets chart notes.
• Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
• Contacts providers regarding appeals and medical policy denials, identifies and collects additional documentation needed and provides appropriate guidance for future practice.
• Retrieves, reviews and interprets 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.
• Assists and mentors junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Recommend proactive changes based on analysis of denial trends to the / Production Unit Manager.

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.
• Must adhere to Service Excellence Standards.
• Customer Relations.
• Self-Management.
• Teamwork.
• Communications.
• Ownership/Accountability.
• Continuous Performance Improvement.

Knowledge, Skills & Abilities

• Ability to use various billing and patient information computer systems.
• Knowledge of various payer processing and submission guidelines.
• Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions.
• Comprehensive knowledge of and compliance with HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Comprehensive knowledge of medical billing applications.
• Utilize online resources to research policy and regulations to facilitate efficient claims processing.
• Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures.
• Excellent interpersonal, communication and customer service skills required.
• Ability to review and interpret chart notes.
• Knowledge of medical terminology, CPT codes and diagnosis coding.
• Ability to perform on-line research and analyze data for conclusive thought.
• Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials.

We are seeking an AR Revenue Cycle Specialist III who will be responsible for the collection of unpaid third-party claims and independent resolution of complex 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. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive guidance for future practice. Review chart notes and interpret data for appropriate conclusive action. 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. Will monitor and identify trends in denials and recommend systematic proactive changes for continuous improvement. Will mentor and advise junior specialists as appropriate.

Specific 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.
• Prepares appeals documentation and incorporates results of medical policy research and interpretation.
• Resolves claim edits.
• Researches medical policies to resolve denials based on medical necessity.
• Researches and applies LCD’s.
• Reviews and interprets chart notes.
• Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
• Contacts providers regarding appeals and medical policy denials, identifies and collects additional documentation needed and provides appropriate guidance for future practice.
• Retrieves, reviews and interprets 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.
• Assists and mentors junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Recommend proactive changes based on analysis of denial trends to the / Production Unit Manager.

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 & Abilities

• Ability to use various billing and patient information computer systems.
• Knowledge of various payer processing and submission guidelines.
• Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions.
• Comprehensive knowledge of and compliance with HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Comprehensive knowledge of medical billing applications.
• Utilize online resources to research policy and regulations to facilitate efficient claims processing.
• Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures.
• Excellent interpersonal, communication and customer service skills required.
• Ability to review and interpret chart notes.
• Knowledge of medical terminology, CPT codes and diagnosis coding.
• Ability to perform on-line research and analyze data for conclusive thought.
• Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials.

Minimum Qualifications

• High School Diploma or graduation equivalent.
• Three years experience in a medical billing, insurance follow-up processing, or similar medical specialty environment required.
• Significant experience and expertise using Epic Resolute for A/R functions and resolution of revenue cycle issues in an academic medicine 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.

Preferred Qualifications

• CPC and/or AHIMA certification preferred.

Classified Title: AR Revenue Cycle Specialist III
Job Posting Title (Working Title):AR Revenue Cycle Specialist III
Role/Level/Range: ATO 40/E/02/OE
Starting Salary Range: $18.20 - $33.90 HRLY ($26.00/hr. targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Monday – Friday, 8:30 A.M – 5:00 P.M.
FLSA Status:Non-Exempt
Location:Remote
Department name: 10003413-SOM Uro Production Unit Billing
Personnel area: School of Medicine

This salary range does not include all components of the Urology Production Unit Billing within the School of Medicinecompensation program. This position may be eligible for a discretionary bonus. Therefore, the actual compensation paid to the selected candidate may vary slightly from the salary range stated herein. For more information, please contact the hiring department.

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.

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.