Reimbursement Specialist

We are seeking a Reimbursement Specialist who will 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.

Specific Duties & Responsibilities

Procedural Knowledge

• 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.
• Participates in the resolution of escalated claims, third party payer issues and payment disputes. Makes 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.

Technical Knowledge

• Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
• Utilize internal and external resources including Epic, electronic medical records, payer websites, and other resources to facilitate efficient operations, issue resolution, and education.
• Excellent communication and customer service skills with the ability to work well under pressure and provide guidance on industry standards, regulations, and payment operations for patients, physicians, administrative staff, team members and payers in a high-volume medical services environment.
• Possess detailed knowledge of medical policies, medical terminology, and National Correct Coding standards including CPT's, diagnosis codes and all modifiers that affect billing and the revenue cycle operations.
• Strong working knowledge of standard invoice processing, payment posting procedures, and generally recognized PBS billing applications and policies.
• Knowledge of managed care contracts, reimbursement policies and JHU variance monitoring systems as applicable

Professional & Personal Development:

• Participate in on-going educational activities.
• Assist in the training of staff.
• Keep current of industry changes by reading assigned material on work related topics.
• Complete three days of training annually

Minimum Skills & Abilities:

• Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
• Physical requirements for the job:
• Able to sit in a normal 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.
• Able to communicate using the spoken and written word.
• Able to see within normal parameters and to hear within normal range.
• Able to move about.
• Able to lift minimum weight, 10 lbs.

• HS/GED required.
• Three years of physicians billing experience required. Four or more years experience in medical billing preferred.
• Working knowledge of medical terminology and coding required.
• Experience with Third Party payors required.
• Experience in developing and analyzing complex spreadsheets required.
  
• Excellent interpersonal and communication skills written and oral required.
• Additional job-related experience beyond minimum experience qualifications may substitute for formal education requirement and additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.
  

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

Classified Title: Reimbursement Specialist
Role/Level/Range: ATO 37.5/02/OE
Starting Salary Range: $18.20 - $33.90 HRLY ($52,616 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30AM-5PM
Exempt Status:Non-Exempt
Location:Hybrid/JH at Middle River
Department name: SOM Admin CPA Third Party Reimbursements
Personnel area: School of Medicine