AR Revenue Cycle Specialist III (Department of Dermatology)

We are seeking an AR Revenue Cycle Specialist III who will be responsible for the collection of unpaid third-party claims and independent resolution of complex 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. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive guidance for future practice. Review chart notes and interpret data for appropriate conclusive action. 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. Will monitor and identify trends in denials and recommend systematic proactive changes for continuous improvement. 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.
• Prepares appeals documentation and incorporates results of medical policy research and interpretation.
• Resolves claim edits.
• Research medical policies to resolve denials based on medical necessity.
• Researches and applies LCD's.
• Reviews and interprets chart notes.
• Resolves issues across different sub-specialties and / or related to specialized, complex or high-cost procedures.
• Contacts providers regarding appeals and medical policy denials, identifies and collects additional documentation needed and provides appropriate guidance for future practice.
• Retrieves, reviews and interprets 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.
• Assists and mentor's junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Recommend proactive changes based on analysis of denial trends to the / Production Unit Manager

Minimum Qualifications

Preferred Qualifications

Classified Title : AR Revenue Cycle Specialist III

Role / Level / Range : ATO 40 / E / 02 / OE

Starting Salary Range : $18.20 - $33.90 HRLY ($55,000 targeted; Commensurate w / exp.)

Employee group : Full Time

Schedule : M - F; 8 : 30am - 5 : 00pm

FLSA Status : Non-Exempt

Location : Hybrid / JH at Middle River

Department name : SOM DOM Production Unit Billing

Personnel area : School of Medicine

Total Rewards

The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education / training and other qualifications. 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 / .

Education and Experience Equivalency

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 Completing Studies

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.

Background Checks

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.

Diversity and Inclusion

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.

EEOis the Law

https : / / www.eeoc.gov / sites / default / files / 2023-06 / 22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

Accommodation 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 jhurecruitment@jhu.edu . For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https : / / accessibility.jhu.edu / .

Vaccine Requirements

Johns Hopkins University requires all faculty, staff, and students to receive the seasonal flu vaccine. Exceptions to the 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.

The following additional provisions may apply, depending upon 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.