"AR Revenue Cycle Specialist III"

Johns Hopkins, founded in 1876, is America's first research university and home to nine world-class academic divisions working together as one university.

We are seeking an AR Revenue Cycle Specialist III who will be responsible for the collection of unpaid third-party claims and independent resolution of complex 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. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive guidance for future practice. Review chart notes and interpret data for appropriate conclusive action. 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. Will monitor and identify trends in denials and recommend systematic proactive changes for continuous improvement. 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.
• Prepares appeals documentation and incorporates results of medical policy research and interpretation.
• Resolves claim edits.
• Research medical policies to resolve denials based on medical necessity.
• Researches and applies LCD’s.
• Reviews and interprets chart notes.
• Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
• Contacts providers regarding appeals and medical policy denials, identifies and collects additional documentation needed and provides appropriate guidance for future practice.
• Retrieves, reviews and interprets 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.
• 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.
• Assists and mentor's junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Recommend proactive changes based on analysis of denial trends to the / Production Unit Manager

Minimum Qualifications

• High School Diploma or graduation equivalent.
• Three years' experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
• Significant experience and expertise using Epic Resolute for A/R functions and resolution of revenue cycle issues in an academic medicine environment.
• Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.

Preferred Qualifications

• CPC and/or AHIMA certification preferred.

Classified Title: AR Revenue Cycle Specialist III
Role/Level/Range: ATO 40/E/02/OE
Starting Salary Range: $18.20 - $33.90 HRLY ($55,000 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: M - F; 8:30am - 5:00pm
FLSA Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM DOM Production Unit Billing
Personnel area: School of Medicine

The successful candidate(s) for this position will be subject to a pre-employment background check.

If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the HR Business Services Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711.

The following additional provisions may apply depending on which campus you will work. Your recruiter will advise accordingly.

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.

The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.

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