The Department of Neurosurgery is seeking a full time Collection Specialist. This person 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 payments not received in response to the claims 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 have an understanding of 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 communications skills coupled with patience and fortitude.
Specific duties & 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.
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 claims 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 reflected claims and claims with low reimbursement.
Confirm credit balances and gathers necessary documentation for processing refund.
Identities 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 informs the supervisor/Production Unit Manager of issues or problems associated with non-payment of claims. Technical Knowledge:
Comprehensive knowledge and compliance of HIPPA 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.
Assist in the training of staff.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.
Department Specific Responsibilities:
Utilize EPIC workqueues to collect third party receivables and resolve third party rejections.
Ability to understand and follow JHU and departmental policies and procedures.
Identify key issues and take appropriate actions to complete rejected and unpaid accounts.
Respond to complex medical insurance inquiries.
Resolve correspondence from third party carries.
Minimum qualifications (mandatory):
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.
Additional education may substitute for required experience, to the extent permitted by the JHU equivalency formula.
EPIC experience preferred.
Ability to use various billing and patient information computer systems preferred.
Knowledge of various payer processing and submission guidelines preferred.
JHU Equivalency Formula:
30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. 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.
Classified title: Collection Specialist
Role/Level/Range: ATO / 02 / OC
Starting Salary Range: $12.97 - $17.87
Employee group: Full Time
Employee subgroup: Non-exempt
Schedule: Monday-Friday, 8:30am-5:00pm
Location: 9910 Franklin Square Drive – White Marsh, MD
The successful candidate(s) for this position will be subject to a pre-employment background check.
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During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.
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