Medical Billing Specialist Level 2 Position Available In Knox, Tennessee

Medical Biller Claims/Denials follow up Onsite fully

Description ON-SITE Shift:

8am – 4:30 pm (First day will start at 9:00am) 1.Acts a resource for Patient Account Representative Is with resolving intermediate to complex account and claims issues. 2.Provides guidance to other departmental roles (including Customer Service, Collections, Payment Posting) as it pertains to plan eligibility, claims processing details, and patient balance explanations as needed. 3.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. 4.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. 5.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. Able to track rejection and denials trends and report to the appropriate contact for tracking and/or further investigation. 6.Demonstrates knowledge and comprehension of State and Federal regulations, Medicare, TennCare, and other Third-Party Payor requirements, assuring departmental compliance. 7.Possess an enhanced 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. 8.Able to find, comprehend, and interpret payor processing and reimbursement policies relevant to assigned tasks. Maintains a working knowledge of medical terminology, CPT and HCPCS code sets, ICD-10 code set, and modifiers as it pertains to work assignment. 9.Demonstrates the ability to extract pertinent information from payor correspondence and documents this in the practice management system. Interprets payor correspondence relevant to account resolutions and takes next steps as appropriate. 10.Responsible for preparing and submitting payor reconsiderations and appeals. References relevant payor policies, claim submission and billing guidelines, and supporting documentation to obtain payor reimbursement in accordance with contracted rates. 11.Analyses overpaid accounts and takes appropriate action to resolve overpayments including initiation of payor recoupment, refunding overpaid dollars to the appropriate party, and making appropriate transaction corrections in the practice management system. 12.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. 13.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. 14.Consults and works collaboratively with leadership, coworkers, other departments, and other facility personnel to ensure accurate exchange of information and appropriate actions to resolve patient account/claims issues. Additional Skills & Qualifications Knowledge of UB and 1500 claims strongly preferred Ability to answer some inbound patient calls regarding more complex claims Follow up with insurance payers on claims denials Knowledge of credit balances