Enrollment & Reimbursement Coordinator

Job Req ID: 114478

Enrollment & Reimbursement Coordinator

We are seeking an Enrollment & Reimbursement Coordinator who will be responsible for enrolling School of Medicine CPA Faculty, JHCP, JHRP-employed clinical providers, and ancillary support staff with government and managed care payers timely and accurately. Provides on-going education and support to providers regarding Credentialing and Provider Enrollment requirements. Works in close collaboration with the clinical departments, Physicians Billing Service, Core Services/Operations, and the Johns Hopkins Central Credentialing Office.

Specific Duties & Responsibilities

• Enrolls School of Medicine CPA Faculty and ancillary support staff with government and managed care payers timely and accurately.

• Follows Medicare PECOS Provider Enrollment Policy and escalates cases when providers have not responded within specified timeframe.

• Reviews and resolves provider enrollment related rejections daily. Follows Provider Not Enrolled (MCOB7) Resolution Policy to enroll deactivated providers immediately.

• Reviews Provider Enrollment Charge Edits timely to identify and enroll providers who need to be enrolled with Railroad Medicare.

• Reviews Provider Enrollment Related Claim Edits timely to ensure providers with outstanding enrollment s are captured on the "All Dept Provider Enrollment Log" and resolved quickly.

• Thoroughly updates "All Dept Provider Enrollment Log" daily and any tracking logs utilizing standardize formatting.

• Ensures GE Provider Dictionary, NPPES website, and Epic SER records are updated with provider's most current Medicare and billing related information timely and accurately.

• Ensures Medicare provider enrollment development letters are responded within 30 days from the date on the letter. Escalates cases to the Enrollment Supervisor by the 20th day if unable to resolve the issue.

• Communicates with the Enrollment Supervisor regarding enrollment applications that are returned to identify issues and cases for appeal.

• Audits SER information and updates provider dictionaries effectively.

• Originates ad hoc data reports and summarizes results.

• Audits payer websites for erroneous or missing provider profile data.

• Manages/ updates provider e-mail lists for the Clinical Practice Association.

• Investigates enrollment impacted third party claims rejections and patient referral denials.

• Third party liaison between production units and insurance networks.

• Coordinates all aspects of JHU-CPA individual provider participation with health insurance carriers under their respective delegated credentialing agreements.

• Assures information obtained and transmitted on providers is accurate and timely, to maximize potential revenue through validated participation in payer's and JHU's respective IS-systems.

• Monitors and/or maintains process by which providers are recognized and enrolled with payers and satisfactorily set-up in Epic.

• Oversees data integrity in the Epic billing system provider dictionary for key billing provider identities.

• Performs routine monitoring of outliers, as identified by a number of sources including the TES (transaction editing system) in Epic. Handles coordination with departments of any necessary corrective actions.

• Serves as principal liaison to JHM hospital's respective Medical Staff Offices and the JHM CVO to address status changes, location, etc and the corresponding impact on billing procedures.

• Registration and attestation for CPA Provider's Meaningful Use Medicaid and Medicare HER.

• Resolve disputes, discrepancies and other provider enrollment related problems, as necessary.

Special Knowledge, Skills & Abilities

• Professional credentialing for commercial and governmental health plans experience required.

• Experience with Third Party payers required.

• Proficient in use of Excel.

• Analytical/problem solving skills required.

• Excellent oral and written communications skills required.

• Ability to interact with all levels of staff.

Minimum Qualifications

• Bachelor's Degree.

• One year of medical office and/or billing experience.

• Additional experience may substitute for required education, to the extent permitted by the JHU equivalency formula.

Preferred Qualifications

• Knowledge of the Epic billing system preferred.

Classified Title: Enrollment & Reimbursement Coordinator

Job Posting Title (Working Title): Enrollment & Reimbursement Coordinator

Role/Level/Range: ATO 37.5/02/OE

Starting Salary Range: $18.00 - $33.50 HRLY ($48,000 targeted; Commensurate with experience)

Employee group: Full Time

Schedule: M-F 8:30 AM - 5:00PM

Exempt Status: Non-Exempt

Location: Remote

Department name: SOM Admin CPA Contract Services

Personnel area: School of Medicine

Total Rewards

The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education/training and other qualifications. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/.

Education and Experience Equivalency

Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: 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.

Applicants Completing Studies

Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.

Background Checks

The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.

Diversity and Inclusion

The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

EEO is the Law

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

Accommodation Information

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 Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https://accessibility.jhu.edu/.

Vaccine Requirements

Johns Hopkins University strongly encourages, but no longer requires, at least one dose of the COVID-19 vaccine. The COVID-19 vaccine does not apply to positions located in the State of Florida. We still require all faculty, staff, and students to receive the seasonal flu vaccine. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. This change does not apply to the School of Medicine (SOM). SOM hires must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of vaccination status. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.

The following additional provisions may apply, depending upon campus. Your recruiter will advise accordingly.

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.

Remote