Medical Biller II, CMG Business Office

Overview

 

Medical Biller II, 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. Serves as a resource for Medical Biller Is, seeking guidance from Supervisor when necessary. 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

• Acts a resource for Medical Biller Is with resolving intermediate to complex account and claims issues.

• 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.

• 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. Able to identify rejection and denials trends and report to the appropriate contact for tracking and/or further investigation.

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

• 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.

• 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.

• 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.

• 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.

• 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.

• 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 pay