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.
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.
Reviews and updates 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.
Confirms 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.
Monitors invoice activity until problem is resolved.
Processes 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.
Performs miscellaneous related duties as assigned.
Minimum Qualifications (Required)
High School Diploma / GED.
One (1) year experience in a medical billing or similar specialty environment.
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.
Special Knowledge, Skills, and Abilities
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
Excellent interpersonal, communication and customer service skills.
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.
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.
Classified Title: Collection Specialist Working Title: Collection Specialist Role/Level/Range: ATO 40/E/02/OC Starting Hourly Pay Rate Range: $13.36 - $18.41 commensurate with experience Employee group: Full Time Schedule: Monday - Friday, 8:30 am - 5:00 pm / Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10003187-SOM Plastic Surgery Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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