Position requires the ability and skills to perform accurate and timely billing and collections, as well as resolve issues related to registration, claims processing, clinical documentation, payor enrollment, and other billing compliance requirements. Provide clinical provider training and tutorials in regards to compliant documentation practices, as well as efficient utilization of the electronic documentation systems. Charge capture and review in JHU/ PBS billing applications or related billing systems may be required. Conduct periodic audits for compliant documentation and compliance to workflow processes and procedures. Audits may also be conducted on an ad-hoc basis. Provide reports to management of progress and noted trends observed in audits and encounters with clinical providers. Report HIPAA violations to appropriate management. Handle inquiries in reference to patient demographics and financial status. Manage work flow, work files, and correspondence in relationship to the position. Attend meetings representing the department. Provide exemplary customer service skills. Other duties as assigned or delegated by departmental management.
Will be required to use the JHM and JHU/ PBS billing applicationsand documentation systems, including any additionally implemented systems. Staff in this position will be required to interact daily with staff at various levels. Strict confidentiality of patient information including charges, treatment plans and diagnosis will be maintained following HIPAA guidelines.
Specific Duties & Responsibilities
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Verifies registration information in the billing system, applying knowledge of medical insurance coverage to enter and edit registration as necessary.
Enters charges into billing system in a timely and accurate manner following established policies and procedures to produce accurate and complete claims.
Compares amounts to source documents and calculates amounts for totals.
Reviews various edit lists and takes appropriate action to correct incomplete claims.
Makes account adjustments where appropriate.
Prints and mails claim forms and statements according to policies and procedures.
Retrieves supporting documents (medical reports, authorizations, etc.) as needed and submits to third-party payers.
Identifies and informs the supervisor/Production Unit Manager of issues or problems associated with non-payment of claims.
Posts insurance rejections and takes appropriate steps to resolve outstanding balances by communicating with third-party payers, patients, physicians, and other parties to resolve unpaid claims, ensuring accuracy of insurance information.
Researches and processes refunds according to departmental policies.
Questions incomplete or inaccurate vouchers and notifies supervisor when appropriate.
Recommends and prepares delinquent accounts for referral to collection agencies or recommends account write-offs.
Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
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.
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.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
High School Diploma/GED required.
One year experience in a medical billing or similar specialty environment required.
Ability to work independently.
Ability to provide training.
Ability to work with managers and staff at a higher level.
Excellent customer service and verbal and written communication skills.
Good organization, time management, and follow up skills.
Excellent interpersonal skills and the ability to interact effectively.
Knowledge of JHM and JHU/ PBS billing applications and documentation systems preferred.
Knowledge of PCs and the ability to operate standard office equipment, such as copy machine, printer, scanner, fax, and calculator.
Classified Title: Billing & Collection Specialist Working Title: Billing & Collection Specialist Role/Level/Range: ATO 40/E/02/OC Starting Hourly Pay Rate Range: $13.23 - $18.23 / Commensurate with Experience Employee group: Full Time Schedule: Monday - Friday, 8:30a - 5:00p / 37.5 hours per week Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10003283-SOM Rad Onc General Administration Personnel area: School of Medicine
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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