Medical Billing Specialist Level 1 Position Available In Knox, Tennessee

Description Patient Account Representative 1

Summary:

This position participates in various functions including the review, correction, submission/resubmission, and/or appeal of rejected, denied, unpaid, or improperly paid insurance claims. This position is responsible for billing and follow-up functions for payors in all financial class categories. This positions also provides patient customer service and releases billing records to approved entities. This position responsible for the timely and accurate completion of assigned tasks to facilitate proper claim processing.

Description:

ON-SITE Shift:

Monday-Friday 8am-4:30pm (first day will start at 9:00am) 1.Provides clerical and administrative support for the billing team. 2.Responsible for daily submission of primary, secondary, and tertiary claim billing via the clearinghouse, payor portals, and paper mailing. Reviews deficient claims (i.e. claim rejections) that are unable to be processed by the payor, makes corrections, and processes rebills as appropriate. 3.Responsible for identifying financial and medical records necessary to support claim filing for all payor types for primary, secondary, and tertiary claims. Obtains and releases relevant documents as appropriate to facilitate timely and accurate claim processing. 4.Demonstrates problem-solving and critical thinking skills in analyzing rejections and/or denials to determine root-cause and best course of action to resolve account issues. 5.Demonstrates knowledge and comprehension of State and Federal regulations, Medicare, TennCare, and other Third-Party Payor requirements, assuring departmental compliance. 6.Possesses a basic understanding of billing regulations, claim submission guidelines, payor policies, Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and payor-specific rejection and denial language; demonstrates the ability to interpret these relevant to determining proper steps needed to resolve accounts. 7.Demonstrates the ability to extract pertinent information from payor correspondence and documents this in the practice management system. 8.Demonstrates the ability to use registration system and payor websites to verify patient plan eligibility, coordination of benefits, and plan participation with the organization to ensure timely and accurate processing of accounts. 9.Retrospectively reviews registration information obtained by clinics impacting claim rejections and/or denials. In cases of incomplete or incorrect registration information, consults payor websites to obtain correct information. When necessary, contacts payors and/or patients via phone or mail to clarify deficient registration information. 12.Provides accurate explanation to patients with questions related to claims processing, plan benefits, and account balances via verbal and written communication. Act as a liaison between the patient, charge entry staff, and office staff in cases of patient dispute of charges billed. Demonstrates good judgment when handling financial discussions with patients, always maintaining a professional and confidential environment. 13.Accurately processes practice management system transactions related to resolution of open accounts including but not limited to adjustments, transfer of payments, and refunds. 14.Properly calculates and applies patient balance adjustments such as Self Pay Discounts and Good Faith Estimate Adjustments in accordance with departmental and organizational policies. 15. Must achieve or exceed minimum expected work quality and quantity metrics as defined by department leadership. Skill set and competency to perform job requirements will be evaluated during initial 90-day training period.