Classified Title: Billing Specialist
Salary: $16.91 - $23.25
Work Schedule/Hours: Monday-Friday/8:30-5p/40 hours
Location: East Baltimore
Personnel area: School of Medicine
The Billing Specialist is responsible for the coordination of the Infusion billing to ensure a smoothly functioning billing operation and good patient relations. This includes coordination of the patients' financial billing responsibilities for the Department of GI at Green Spring Station. Requires an in depth knowledge of the EPIC Professional billing systems, as well as the scheduling and registration systems. Activities, which consist of obtaining and verifying financial and insurance information prior to actual time of service. Requires extensive knowledge of insurance contracts, medical benefits programs, medical terminology and coding. Other tasks include medical benefits co-pay collections, collections cash control, reconciliation of cash and charges, charge entries and related activities. Assumes administrative tasks, special projects, report of billing and collections, research patients' financially obligations, and other related activities.
Management of Infusion Medical Benefits programs
Responsible for sending all Explanation of Benefits to appropriate Medical Benefits programs.
Responsible to track all payments from Medical Benefits programs and ensure payments post to the patient account
Responsible to contact patients and arrange payments for patients who receive checks from the Medical Benefit programs
Responsible to obtain prior authorizations for all infusion patients at the GI GSS Infusion center and Knoll North Infusion center.
Obtains and verifies financial and insurance information from patients prior to time of service, including Managed Care authorizations and referrals.
Responsible to manage enrollment of patients into the Medical Benefits programs
Provides weekly reports to GI Finance Manager and Infusion Medical Director on collections
Troubleshoots all insurance coverage for patients, prior to time of service, regarding off label use of drugs.
Obtains proper documentation and supporting data, from the ordering physician. Writes letter of medical necessity, when required.
Manages the insurance verification of all new infusion treatments.
Develops and maintains computer spreadsheets on patients' financial responsibilities, benefits enrollment status, last clinic visit (to ensure we receive payment) and presents data to the administration.
Pre plans patients' financial responsibilities prior to time of service and inform patients of self-pay responsibilities. Follows all guidelines within the Policy and Procedure Manual for GI at Green Spring.
Complete benefits investigation for all patients
Initiates budget payment plans utilizing the Clinical Practice Association's Policy and Procedure Manual Budget Plan Matrix.
Initiates and coordinates refunds with the assistance of the CPA billing offices at White Marsh, including providing the proper documentation when needed.
Resource for HMO and insurance guidelines for both billing and registration staff.
Handles special projects from the billing and clinical managers. These projects consist of auditing specific infusion drugs used within the clinic and cross referencing them with the EPIC billing systems and COGNOS.
Audits charge capture daily. Troubleshoots any questionable encounters, works closely with the nurses staffing, Finance Manager and Medical Director, to accomplish this goal.
Keeps current on all new policy changes for insurances, HMOs and implement changes, monitoring for compliance.
Assists GI patients with their bills and/or billing concerns.
Works directly with the CPA billing department regarding write offs, late payments, collects involving Green Spring GI patients. Obtains approval from Medical Director and GI Finance Manager before writing off any bills.
Acts as a representative on numerous billing committees and national organizations.
Special knowledge, skills, and abilities:
Extensive knowledge of third party payers' pre-certification, authorization process.
Knowledge of professional fee structure and reimbursement
Excellent communication skills, both written and oral
On a regular and continuous basis, exercises administrative judgment and assumes responsibility for decisions, consequences and results having an impact on patients and their families, costs, and /or quality of service within the functional area.
High School Diploma/GED. Medical terminology, anatomy, and physiology courses or demonstrated appropriate knowledge.
Requires a minimum of one year related experience in medical billing and demonstrated analytical skills.
Two years college, ICD-10/CPT knowledge.
Three years pro fee/collections experience
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 HR Business Services Office at email@example.com. For TTY users, call via Maryland Relay or dial 711.
The following additional provisions may apply depending on which campus you will work. Your recruiter will advise accordingly.
During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.
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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School of Medicine - East Baltimore Campus
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