We are seeking an AR Revenue Cycle Specialist to be 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.

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.
  
• 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.

• High School Diploma or graduation equivalent.
• One year experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.

Classified Title: AR Revenue Cycle Specialist 
Role/Level/Range: ATO 40/E/02/OC  
Starting Salary Range: $15.70 - $25.25 HRLY ($50,000 targeted; Commensurate with experience) 
Employee group: Full Time 
Schedule: M-F; 8-4:30 
Exempt Status: Non-Exempt 
Location: Hybrid/School of Medicine Campus 
Department name: ​​​​​​​SOM Ped Production Unit Billing  
Personnel area: School of Medicine