Classified Title: CO Insurance Resolution Specialist
Starting Salary Range: 14.81-20.38
Employee group: Full-Time
Employee subgroup: Non-Exempt
Schedule (hours/days): 40 hours per week; Monday-Friday
Location: White Marsh
Johns Hopkins Medicine implemented integrated patient registration. Patient registration information [demographic, guarantor and coverage] is shared by all JHHS Hospitals, JHCP and the School of Medicine patient services locations. Updates to a patient’s registration are made on account level and impact all claims regardless of where in the system the claim is generated. Accuracy and subject matter expertise is critical to preserve the integrity of the revenue cycle across JHM as patient records are updated. The complexities of the patient registration system, payers and payer requirements necessitate staff updating patient registration to be medical insurance subject matter experts, highly knowledgeable with the varying payer, clinical specialty and facility requirements, system savvy, analytical, and highly detail oriented. In addition, staff must work well under pressure; effectively and efficiently use all internal and external technology and applications relevant to researching, analyzing and resolving registration errors, while maintaining productivity and quality standards.
To resolve complex coverage issues, staff is expected to make outbound calls to patients, payers, or the Office of Managed Care and collaborate with production unit, customer service and/or self-pay staff to fully and correctly correct a patient’s account. In this role of subject matter expert staff is expected to respond production unit A/R and Customer Service staff requiring assistance in correcting a patient’s registration record.
Principal Duties and Responsibilities:
Responsible for accurately investigating eligibility issues with a patient’s account for which the claim could not be submitted to the payer or was rejected by the payer.
Applies analytical skills to assess rejection scenarios and applies best practice workflows to accurately work the account
Effectively utilizes all systems and resources available to resolve patient registration issues and ensures the correct coverage is added to the patient account.
Effectively manages workload to meet the unit’s goals and individual productivity and quality standards.
Corrects all accessible systems with correct insurance information to minimize system overrides from source systems so future claims are processed efficiently expediting revenue recovery by preventing future rejections.
Collaborates and communicates with patients, and other internal or external stakeholders, i.e. production unit staff, or other core unit staff, payers or the office of managed care to resolve high level registration issues quickly and accurately.
Accurately and comprehensively documents activities and results in the billing system and applies the correct error classification code.
Provides subject matter expert support to staff in other core units or to super users in production units.
Recognizes potential error patterns and trends, which may warrant further investigation and informs leads or unit manager discovery.
Communicates payer specific, department or user issues identified during the investigative process to leads.
Exhibits a comprehensive knowledge of regulatory compliance and HIPAA rules, regulations in the dissemination of patient Protected Health Information (PHI).
Files/Refiles invoices to the correct insurance company.
Expert knowledge of Payor and Plans, and clinical specialty requirements as they relate to patient registration
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Efficiency in SOM billing application, Epic registration application, as well as other relevant application such and OnBase, or the Hopkins Electronic Medical Record.
Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development:
Participates in on-going educational activities.
Assists in the training of staff.
Keeps on work related topics.
Completes three days of training annually.
Department Specific Requirements:
Must be able to complete all relevant system training and acquire proficiency Epic Prelude (patient registration function).
Must attend and meet all requirements related to the 6-day insurance training.
Has a basic understanding of front end workflows and is able to identify patterns that may require intervention and further investigation by leads or manager.
Has a full understanding of the professional fee billing process.
Understand and follow JHU and supporting departmental policies and procedures.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
Requires a high school diploma/GED
A minimum of 2 years current experience in medical billing, front end operations or a similar environment is required. A minimum of three years if preferred.
Must exhibit strong communication, analytical and organizational skills.
Must be able to work under pressure and accustomed to meeting production and quality standards
CPT, ICD, Medical Terminology preferred.
Knowledge of Epic, IDX, and Meditech preferred.
Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.
Minimum Skills & Abilities:
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
Physical requirements for the job:
Able to sit in a normal 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.
Able to communicate using the spoken and written word.
Able to see within normal parameters and to hear within normal range.
Johns Hopkins University remains committed to its founding principle, that education for all students should be grounded in exploration and discovery. Hopkins students are challenged not just to learn but also to advance learning itself. Critical thinking, problem solving, creativity, and entrepreneurship are all encouraged and nourished in this unique educational environment. After more than 130... years, Johns Hopkins remains a world leader in both teaching and research. Faculty members and their research colleagues at the university's Applied Physics Laboratory have each year since 1979 won Johns Hopkins more federal research and development funding than any other university. The university has nine academic divisions and campuses throughout the Baltimore-Washington area. The Krieger School of Arts and Sciences, the Whiting School of Engineering, the School of Education and the Carey Business School are based at the Homewood campus in northern Baltimore. The schools of Medicine, Public Health, and Nursing share a campus in east Baltimore with The Johns Hopkins Hospital. The Peabody Institute, a leading professional school of music, is located on Mount Vernon Place in downtown Baltimore. The Paul H. Nitze School of Advanced International Studies is located in Washington's Dupont Circle area.