We are seeking an Enrollment & Reimbursement Coordinator.
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 providers 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 payers and JHUs 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 hospitals 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 Providers 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.
Experience with Third Party payers.
Proficient in use of Excel.
Analytical/problem solving skills.
Excellent oral and written communications skills.
Ability to interact with all levels of staff.
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.
Bachelor's Degree, and at least 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.
Knowledge of the Epic billing system.
Classified Title: Enrollment & Reimbursement Coordinator Role/Level/Range: ATO 40/E/02/OE Starting Hourly Pay Rate Range: $17.95-$25.30-$32.60 HRLY (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 Contract Services 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.
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.
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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.
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