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.

• 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