Medical Biller I, CMG Business Office

Overview

 

Medical Biller I, CMG Business Office

Full time, 80 hours per pay period, Day shift

 

Covenant Medical Group is Covenant Health’s employed and managed medical practice organization, with more than 300 top Physicians and providers spanning the continuum of care in 20 cities throughout East Tennessee. Specialties include cardiology, cardiothoracic surgery, cardiovascular surgery, endocrinology, gastroenterology, general surgery, infectious disease, neurology, neurosurgery, obstetrics and gynecology, occupational medicine, orthopedic surgery, physical medicine and rehabilitation, primary care, pulmonology, reproductive medicine, rheumatology, sleep medicine and urology.

 

Position 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.

 

 

Recruiter: Kathleen Rice || kkarnes@covhlth.com ||  (865) 374-5386

Responsibilities

• Provides clerical and administrative support for the billing team.

• 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.

• 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.

• 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.

• Demonstrates knowledge and comprehension of State and Federal regulations, Medicare, TennCare, and other Third-Party Payor requirements, assuring departmental compliance.

• 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.

• Demonstrates the ability to extract pertinent information from payor correspondence and documents this in the practice management system.

• Demonstrates the ability to use registration system and payor websites to verify patient plan eligibility, coordination of benefits, and plan participation with CMG to ensure timely and accurate processing of accounts.

• Retrospectively reviews registration information obtained by CMG 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.

• 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.

• Communicates effectively and professionally with patients/public, coworkers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.

• 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.

• Accurately processes practice management system transactions related to resolution of open accounts including but not limited to adjustments, transfer of payments, and refunds.

• Properly calculates and applies patient balance adjustments such as Self Pay Discounts and Good Faith Estimate Adjustments in accordance with departmental and organizational policies.