We are seeking a Collections Specialist who will 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. Will 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. The Specialist will use a comprehensive knowledge of claims submission requirements for all payors in order to expedite payments. The Specialist will 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. 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.
• Review and update patient registration information (demographic and insurance) as needed.
• Resolves claim edits.
• Drafts and resolves non-standard appeals.
• Research medical policies to resolve denials based on medical necessity.
• Researches and applies LCD's.
• Resolves issues across different sub-specialties and/or related to specialized, complex or high-cost procedures.
• Applies appropriate discounts / courtesies based on department policy.
• Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
• 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.
• 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.
• Advises junior specialists as appropriate, confirms and assumes responsibility for escalated issues.
• Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims and non-standard appeals.

• High School Diploma or graduation equivalent.
• Two year's experience in a medical billing, insurance follow-up processing, or similar medical specialty environment required.

• Knowledge of medical terminology, CPT/ICD codes and diagnosis coding required preferred.

Classified Title: Collection Specialist
Role/Level/Range: ATO 37.5/02/OC
Starting Salary Range: $15.50 - $25.00 HRLY ($49,000 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F, 7a-330p or 8a-430p
Exempt Status:Non-Exempt
Location:Hybrid/School of Medicine Campus
Department name: SOM PMR Production Unit Billing
Personnel area: School of Medicine