Enrollment & Reimbursement Coordinator

General Summary/Purpose

• 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 maintainsprocess 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 principle 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.

Minimum Qualifications(Required)

• Bachelor’s degree required
• One year of medical office and or billing experience.

Additional experience may substitute for education:* 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 the 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. *

Special Knowledge, Skills, and Abilities

Professional credentialing for commercial and governmental health plans experience required

• Experience with Third Party payers required.
• Proficient in use of Excel.
• Knowledge of the Epic billing system preferred.
• Analytical/problem solving skills required.
• Excellent oral and written communications skills required.
• Ability to interact with all levels of staff.

Classified Title: Enrollment & Reimbursement Coordinator
Working Title: Enrollment & Reimbursement Coordinator
Role/Level/Range: ATO 40/E/02/OE
Starting Hourly Pay Rate Range:$17.43 - $23.95 per hour/Commensurate with Experience
Employee group: Full Time
Schedule:Monday - Friday, 8:30 am- 5:00 pm / 40 hrs per week
Exempt Status: Non-Exempt
Location:20-MD:JH at Franklin Square
Department name: 10002655-SOM Admin CPA Contract Services
Personnel area: School of Medicine

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 atjhurecruitment@jhu.edu. 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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