We are seeking a AR Revenue Cycle Specialist II responsible for the collection of unpaid third-party claims and resolution of non-standard 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. 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. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The Specialist will research and interpret medical policies regarding denials based on medical necessity. Will use a working knowledge of local coverage determinations (LCD’s) to research and apply appropriately. Will mentor and advise junior specialists as appropriate.

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
• Drafts and resolves non-standard appeals.
• Researches medical policies to resolve denials based on medical necessity
• Researches and applies LCD’s
• Resolves issues across different sub-specialties and/or related to specialized, complex or high cost procedures.
• 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.
• 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.
• Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims and non-standard appeals.

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 to 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.
• Knowledge of medical terminology, CPT codes and diagnosis coding.
• Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials.
• Ability to perform on-line research and analyze data for conclusive thought.

Physical requirements for the job

• Able to sit in a 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.

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

Classified Title: AR Revenue Cycle Specialist II  
Role/Level/Range: ATO 40/E/02/OD  
Starting Salary Range: $16.00 - $28.50 HRLY ($46,280 targeted; Commensurate with experience) 
Employee group: Full Time 
Schedule: M-F; 40hrs 
Exempt Status: Non-Exempt 
Location: Hybrid/JH at Middle River 
Department name: ​​​​​​​SOM DOM Billing  
Personnel area: School of Medicine