The Collections Specialist will be responsible for the collection of unpaid third-party claims and appeals, using various applications of JHM and JHU/ PBS billing applications. Works with the 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 be assigned payor groups of outstanding patient accounts. Various methods of follow-up will be used including all JHU/ PBS Billing Applications. The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the JHM registration process and be able to recognize and resolve incorrect demographic and insurance registration. The Specialist must have an understanding of claims submission requirements for all payors to expedite payments as well as knowledge of appeals and rejections processing. This position requires excellent communication skills coupled with patience and fortitude.
Principal Duties and 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.
*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.
*Process daily mail, edits reports, file or pull EOB batches.
*Identifies and informs the Supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
*Other duties as assigned.
*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. Must pass training provided by PBS.
*Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development:
*Participate in on-going educational activities.
*Assist in the training of other 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.
- Customer Relations
- Continuous Performance Improvement
One (1) year experience in a medical billing or similar specialty environment required.
Excellent interpersonal, communication and customer service skills required.
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.
Able to move about.
Able to lift minimum weight, 10 lbs.
JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
Knowledge of medical terminology, CPT codes and diagnosis coding preferred.
Ability to use various billing and patient information computer systems preferred.
Knowledge of various payer processing and submission guidelines preferred.
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.