Responsible for the collection of unpaid third party claims and appeals using various application of JHM and JHU/PBS billing applications.
Work with payors 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. Will be assigned payor groups of outstanding patient accounts. Various methods of follow-up will be used including all JHU/PBS Billing Applications.
Use A/R follow-up systems and reports to identify unpaid claims for collection/appeal. Gather and verify all information required to produce a clean claim including special billing procedures that may be defined by a payor or contract. Review and update patient registration information (demographic and insurance) as needed. Apply appropriate discounts/courtesies based on department policy. Prepare delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix. Retrieve supporting documents (medical reports, authorizations, etc.) as needed and submits to third-party payors. Appeal rejected claims and claims with low reimbursement. Confirm credit balances and gather necessary documentation for processing refunds. Identify insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issues causing non-payment of claims. Contact payors or patient as appropriate for corrective action to resolve the issue and receive payments of claims. Monitor invoice activity until problem is resolved. Process daily mail, edit reports, file or pull EOB batches. Identify and inform the supervisor/Production Unit
Manager of issues or problems associated with non-payment of claims.
Use comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). Use working knowledge of JHU/PBS Billing Applications. Utilize online resources to facilitate efficient claims processing. Participate in on-going educational activities. Assist in the training of staff. Keep current of industry changes. Complete three days of training annually.
Perform other duties as required.
High School or GED Required. One year experience in a medical billing or similar specialty environment required.
Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula. Knowledge of medical terminology, CPT codes and diagnosis coding required.
**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.**
Excellent interpersonal, communication and customer service skills required. Must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the JHOC registration process. Must be able to recognize and resolve incorrect demographic and insurance registration process. Must be able 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. Requires excellent communication skills coupled with patience and fortitude. Able to left minimum weight, 10 lbs.
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