We are seeking a Collection 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 (Epic). The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the Epic 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 Cuties & 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.
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/denied 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. (By phone or use of payer websites).
Monitor invoice activity until problem is resolved.
Process daily mail, edits reports, file or pull EOB batches.
Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
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. (Epic preferred)
Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development
Participate in on-going educational activities.
Assist in the training of staff as applicable.
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.
Continuous Performance Improvement
1.One year experience in a medical billing or similar medical specialty environment required.
2.Knowledge of medical terminology, CPT codes and diagnosis coding preferred.
3.Excellent interpersonal, communication and customer service skills required.
4.Ability to use various billing and patient information computer systems preferred.
5.Knowledge of various payer processing and submission guidelines preferred.
6.Epic knowledge preferred, but not required.
One year experience in a medical billing or similar medical specialty environment required.
Knowledge of medical terminology, CPT codes and diagnosis coding preferred.
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.
Epic knowledge preferred, but not required.
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
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 Working Title: Collection Specialist Role/Level/Range: ATO 37.5/02/OC Starting Salary Range: Min $15.00 - Max $24.50 HRLY ($49,000 budgeted; Commensurate with experience) Employee group: Full Time Schedule: M-F; 8-4:30p Exempt Status: Non-Exempt Location: Hybrid/School of Medicine Campus Department name: SOM PMR Production Unit Billing Personnel area: School of Medicine
Total Rewards The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. 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/
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 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.
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