Medical Biller

Medical Biller

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region's top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area's largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes "Best Employer" seven times.

Position Overview:

Demonstrates expanded knowledge of the billing requirements for UB and 1500 claims for acute care facilities and professional services. This position is responsible coordinating daily workflow for accurate submission of insurance claims to payers to ensure timely reimbursement for services provided. Provides support and assistance for the Medical Biller I for solving complex medical claim issues. This position demonstrates the ability to accurately submit claims in all payer categories, i.e., Medicare, TennCare, Blue Cross, Commercial, and Managed Care. This position assists the Billing Coordinator, Billing Supervisors and Manager.

Coordinates and prioritizes daily responsibilities including evaluating complex errors on medical claims with the understanding of the billing process and reimbursement in a timely manner.

Responsible for ensuring the accuracy of the UB and 1500 medical claim information including evaluating, recognizing, and resolving issues related to the complex medical claims.

Responsible for resolving complex patient and insurance information pre-bill as identified on daily failed bill reports from the patient accounting system to ensure that the claim can be processed in an accurate and timely manner.

Analyzes claim edits within billing system and payer sites with a variety of different issues, such as improper match of diagnosis, revenue codes, modifiers, charging units, physician's NPI, and HCPCS/CPT codes, to facilitate claims processing in a timely manner. Identifies trends and investigates root cause of errors. When indicated, provides supporting medical records documentation for rejected, denied, and suspended or pended medical claims. Demonstrates enhanced knowledge and comprehension of State and Federal regulations, Medicare, TennCare, and other Third-Party Payer requirements to meet regulatory compliance and standards that ensure appropriate reimbursement is received. Demonstrates an enhanced understanding of payer's electronic transaction advice (ERA) and the claim rejection and denial codes (835) to determine and take appropriate actions for resolution and for secondary billing processes.

Responsibilities

• Assists Billing Supervisor to recognize and identify issues pertaining to the working of accounts.
• Demonstrates the ability to handle varying tasks as well as understanding and interpreting procedures relative to the revenue process.
• Demonstrates knowledge of State and Federal regulations, HIPAA guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance.
• Recognizes situations, which necessitate supervision and guidance, seeks appropriate resources.
• Demonstrates an ability to understand the payer requirements of insurance carriers.
• Demonstrates an understanding of all patient information from the facilities and the specifics of each follow-up to ensure appropriate reimbursement is received.
• Professionally deals with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Performs specific functions relating to billing of patient accounts.
• Consults and works collaboratively with Supervisors, Co-Workers, Department management, and other facility personnel, effectively performing tasks of position.
• Attends meetings as required and participates on committees as directed.
• Perform other duties as assigned or requested.
• Promotes good public relations for the department ad the facilities, adhering to desired behaviors.
• Participates freely in intradepartmental quality improvement activities whenever called upon to do so.
• Demonstrates promptness in reporting for and completing work, ensuring follow-through on assigned tasks.
• Demonstrates initiative in increasing skills and attends training programs as available.
• Utilizes resources available appropriately, i.e. use of equipment and supplies.
• Supports, models and adheres to the desired behaviors of the KBOS Constitution for using the community's resources wisely which are; be aware of cost and quality when making spending decisions, demonstrate a personal commitment to reduce waste, consider the impact on other departments and facilities within Covenant health when making decisions or taking action and ensure that meetings lead to solutions.

Qualifications

Minimum Education:

Minimum Experience:

Licensure Requirements:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.

One to Two (1-2) years' experience in health care is preferred. Computer experience is required. Knowledge of medical terminology, claims submission, customer service is preferred. Expected to perform adequately within the position after working at least three (3) to six (6) months on the job. Must be familiar with insurance plans and requirements and collection practices e.g. Fair Debt Credit and Collection Act.

None.