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 claim's submission process, either electronically or by paper. We are seeking a Collection Specialist who will be assigned payor groups of outstanding patient accounts. Various methods of follow-up will be used including all JHU/ PBS Billing Applications. Must have expertise in insurance follow-up processing. Knowledgeable in CPT and diagnosis coding as well as understand the JHOC registration process. Ability to recognize and resolve incorrect demographic and insurance registration. 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.
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.
- 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 according to the follow-up matrix.
- Retrieves 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.
- Works assigned mail correspondence.
- Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
- 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.
- Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development
- Participate in on-going educational activities.
- Keep current of industry changes by reading assigned material on work related topics.
- Assist in the training of staff when requested.
- Complete three days of training annually.
Department Specific Responsibilities
- To be able to work in a remote work environment while maintaining protected PHI guidelines.
- To be able to meet departmental production expectations.
- Have the ability to multi-task.
- To incorporate strong problem-solving skills.
- Must adhere to Service Excellence Standards.
- Customer Relations.
- Continuous Performance Improvement.
- High School Diploma or graduation equivalent.
- One year experience in a medical billing or similar specialty environment.
- Knowledge of medical terminology, CPT/ICD codes and diagnosis coding.
- Excellent interpersonal, communication and customer service skills.
Classified Title: Collection Specialist
- Ability to use various billing and patient information computer systems.
- Knowledge of various payer processing and submission guidelines.
Role/Level/Range: ATO 40/E/02/OC Starting Hourly Pay Rate Range: $15.00-$19.90-$24.50 HRLY (Commensurate with experience)
Employee group: Full Time Schedule: Monday - Friday, 8:30 am - 5:00 pm
Exempt Status: Non-Exempt Location: Hybrid/JH at Middle River
Department name: SOM OB GYN Production Unit Billing
Personnel area: School of Medicine Total Rewards
The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines:
JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. 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.
**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion
.Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.EEO is the Law
Learn more:https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdfAccommodation Information
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 Talent Acquisition Office at email@example.com
. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit accessibility.jhu.edu
Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/
and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/
.The following additional provisions may apply, depending on campus. Your recruiter will advise accordingly.
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.
Note: Job Postings are updated daily and remain online until filled.To apply, visit https://jobs.jhu.edu/job/Middle-River-Collection-Specialist-MD-21220/1004056600/
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