The Department of Psychiatry Production Unit is seeking a Billing & Collection Specialist to 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.
Specific Duties & Responsibilities
- Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
- 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.
- Use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments.
- 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.
- Mentor and advise junior specialists as appropriate.
Professional & Personal Development
- Participate in on-going educational activities.
- Complete three days of training annually.
Must adhere to Service Excellence Standards
- Customer Relations
- Self-Management
- Teamwork
- Communications
- Ownership/Accountability
- Continuous Performance Improvement
Knowledge, Skills & Abilities
- Ability to use various billing and patient information computer systems.
- Knowledge of various payer processing and submission guidelines.
- Able to maintain consistent above average productivity due to comprehensive knowledge, and ability to make data based and timely decisions.
- Comprehensive knowledge of and compliance to HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
- Comprehensive knowledge of medical billing applications.
- Utilize online resources to research policy and regulations to facilitate efficient claims processing.
- Ability to resolve issues across different sub-specialties, and/or specialized/complex high value procedures.
- Excellent interpersonal, communication and customer service skills required.
- Knowledge of medical terminology, CPT codes and diagnosis coding.
- Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials.
- Ability to perform on-line research and analyze data for conclusive thought.
Physical Requirements
- Able to sit in a 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.
Minimum Qualifications
- High School Diploma or graduation equivalent.
- Two year's experience in a medical billing, insurance follow-up processing, or similar medical specialty environment.
Classified Title: AR Revenue Cycle Specialist II
Job Posting Title (Working Title): Billing & Collection Specialist
Role/Level/Range: ATO 40/E/02/OD
Starting Salary Range: $16.00 - $28.50 HRLY ($40,560 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M - F/ 40 hours a week
Exempt Status: Non-Exempt
Location: Hybrid/School of Medicine Campus
Department name: SOM Psy Production Unit
Personnel area: School of Medicine
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