Reimbursement Specialist

We are seeking a Reimbursement Specialist who will serve as an information resource on payor medical policies, reimbursement policies and billing requirements. Maintain 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

• 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.

• 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

• 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.

Special Knowledge, Skills & Abilities

• Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
• Working knowledge of medical terminology and coding.
  

• Experience with Third Party payors.
  

• Experience in developing and analyzing complex spreadsheets.
  

• Excellent interpersonal and communication skills.

Physical Requirements

• 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.

• High School Diploma or gradation equivalency.
• Three years of physician billing experience.
• Additional education may substitute for required experience to the extent permitted by the JHU equivalency formula.

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

Classified Title: Reimbursement Specialist
Role/Level/Range: ATO 40/E/02/OE
Starting Salary Range: Min $18.00 - Max $33.50 HRLY ($52,616 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30A-5P
Exempt Status: Non-Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Admin CPA Third Party Reimbursements
Personnel area: School of Medicine

Total Rewards
The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. 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/

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 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.

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.

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

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 accessibility.jhu.edu.

Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. The COVID-19 vaccine does not apply to positions located in the State of Florida. 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. 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 on 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.

Note: Job Postings are updated daily and remain online until filled.