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AR Revenue Cycle Specialist II

Job Description

The Department of Surgery is seeking an AR Revenue Cycle Specialist II that will be 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 claim's 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 cosr 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 in the area of Customer Relations, Self-Management, Teamwork, Communications, Ownership/Accountability, and Continuous Performance Improvement.


Minimum Qualifications
  • 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: $16.20 - $28.80 HRLY ($50.000 targeted; Commensurate with experience) 
Employee group: Full Time 
Schedule: M- F, 9 - 5 
Exempt Status: Non-Exempt 
Location: Remote 
Department name: SOM Sur Production Unit Billing  
Personnel area: School of Medicine 

 

 

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