Johns Hopkins Medicine Billing Analyst, Medicare Advantage in Glen Burnie, Maryland
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Billing Analyst, Medicare Advantage
Requisition #: 168299
Location: Johns Hopkins Health Care,
Glen Burnie, MD
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: April 16, 2018
Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
The Analyst serves as subject matter expert on Medicare Advantage Premium Billing. Primary responsibilities include interfacing with our vendor to ensure compliance with CMS regulations; participate in audits to verify standards for processing turnaround times, submission deadlines and quality standards are being met. Oversee and maintain business processes that govern Premium Billing functions as they relate to member billing, recording payments, reconciling membership payment elections, developing and notifying delinquent members and issuing member refunds. Also collaborates with Finance on premium payment reconciliation.
The Analyst provides customer service resolution and responses to internal inquiries and externally to our members.Complete outbound calls to members to explain specific Premium Billing actions on member accounts and resolve member concerns, escalated issues or complaints.Duties also include reviewing monthly reports to identify all past due members accounts and issue notifications according to CMS guidance and regulation. Resolve reconciliation reports related to terminated members and outstanding Premium Billing statuses billing and/or payments. Manually review membership records to validate delinquency statuses. Retrieve and analyze vendor reports for reconciliation of auto payment statuses and declined payments.Make recommendations to improve processes that cause member dissatisfaction and work with vendor and internal departments to implement agreed improvements.
Requires an Associates Degree in Business, HealthCare Management or related discipline. Additional work experience specifically related to Medicare Advantage may substitute for educational requirements.
Requires thorough knowledge and understanding premium billing functions and processes. Must be able to understand medical terminology.
Requires knowledge of or ability to quickly grasp CMS requirements and the impact to business premium billing operations, payment and account reconciliation.
Knowledge of claims processing, adjustments and analytics is required.
Must demonstrate ability to resolve issues quickly, make decisions and institute change when appropriate.
Must possess the ability to draw accurate and timely conclusions and be able to communicate them effectively to management, other staff members and external clients while being sensitive to the contractual and client relationships at stake.
Must demonstrate the ability to be self-motivated, have excellent organizational, oral and written communication skills.
Requires strong analytical ability to bring together and solve complex problems.
Must have the resourcefulness to think outside of the box when needed.
Must be very detailed oriented and be able to maintain focus while working with large sets of data.
Must be able to multitask and prioritize work when needed.
Must demonstrate (at a minimum) intermediate skill level with Microsoft office packages, specifically EXCEL and WORD with the ability to create and manipulate program worksheets.
- Required Licensure, Certification,
E. Work Experience:
Requires a minimum of 3 years of experience Premium Billing preferably in the healthcare industry.
F. Machines, Tools, Equipment:
Must be able to operate a PC, PC applications, and general office and communications equipment.
A. Budget Responsibility:
No budget responsibility but makes cost conscious decisions regarding purchase “recommendations” and considers cost effective alternatives.
B. Authority/Decision Making Level:
Independently organizes and prioritizes work to meet changing priorities.
Makes decisions within the scope of authority and established guidelines.
C. Supervisory Responsibility:
Must be able to analyze complex data, determine appropriate next steps and use critical thinking to research problems regarding system testing and benefit adjudication rule setup.
Must be able to draw conclusions from data, develop and track trends, recommend solutions and suggest policy revisions as necessary.
Must be able to identify system and or process deficiencies and provide recommendations for improvement.
Must be able to clearly communicate those recommendations to management.
Works in normal office environment where there are no physical discomforts due to temperature, noise, dust etc.
Works requires minimal travel.
Work is sedentary in nature but some standing, stooping, bending and walking is required. The work also requires keyboard activity, filing and duplicating.
Work can produce fatigue due to attention to detail and adherence to deadlines.
Additional hours to complete projects may be required.
Pay Grade: NF
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.