CO Reimbursement Specialist

full-time position with Physicians Billing Service; 40 hours per week; Monday – Friday

Serve as an information resource on payor medical policies, reimbursement policies and billing requirements, maintaining a thorough knowledge of various insurance policies and billing requirements. Resolve or assist in the resolution of claim processing or payment disputes.

• On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve receivable collectability and staff efficiencies;
• Proactively research, interpret, and communicate complex Third Party Payer guidelines and specifications that impact accurate claims submission, payments ,and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties;
• Initiate and hold meetings, onsite sessions, and conference calls with Third Party Payers, Production Unit Managers and staff for issue resolution and education;
• Assist in enhancing communication throughout PBS, as well as, creating training guides and job-aides to educate billing staff utilizing payer websites, surveying payers' contacts and other resources.
• Develop and maintain liaisons with Third Party Payer representatives through face to face meetings, telephone interactions and written correspondence to enhance contractual compliance, payment accuracy and understanding of carrier system workflows and policies;
• Participate in the resolution of escalated claims, third party payer issues and payment disputes. Make referrals to appropriate resources as needed;
• Assist Unit Manager in compiling and analyzing spreadsheets for special projects.
• Generate and analyze Variance reports on specific payors, departments, physicians and/or procedures as back up to the third party department.

Perform other duties as required.

Qualifications

High School Diploma or GED. Three years of physicians billing experience. Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula. Working knowledge of medical terminology and coding. Experience with Third Party payors. Experience in developing and analyzing complex spreadsheets. Excellent interpersonal and communication skills written and oral. Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc. Able to lift minimum weight, 10 lbs.

**JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. 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.**

Preferred Qualifications

Associate's degree in related field preferred. Four or more years’ experience in medical billing. Experience in standard payment posting practices. Advanced knowledge of MS Excel, and Word required, working knowledge of Access. Knowledge of IDX billing system.

NOTE: The successful candidate(s) for this position will be subject to a pre-employment background check.

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 School of Medicine HR Divisional Office at 410-955-2990. For TTY users, call via Maryland Relay or dial 711.

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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.

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