Medical Biller
for section headings: e.g., About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We should only include sections that have real specific content. The posting includes overview, responsibilities (detailed list), minimum education/experience/licensure (requirements/qualifications). No explicit Benefits, Pay, Schedule given (though mentions "Full Time, 80 Hours Per Pay Period, Day Shift" – that's schedule info: full time, 80 hours per pay period, day shift. That is schedule info. So we can include a Schedule section. No explicit Pay or Benefits. So we should not include Pay or Benefits sections.
We need to avoid repeating job title as heading. The job title is not given explicitly; maybe "Medical Biller II"? Not in text. So fine.
We need to use - for any list of duties/requirements/benefits. Use
for prose.
We need to preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc.
We need to include sections only when posting has real specific content.
Thus sections: About the role (maybe combine Covenant Health Overview and Position Overview?), Responsibilities, Requirements (or Qualifications), Skills, Schedule.
We need to decide headings: "About the role" could contain overview of Covenant Health and position overview. "Responsibilities" list duties. "Requirements" could contain minimum education, experience, licensure. "Skills" could contain knowledge of medical terminology, claims submission, computer experience, etc. "Schedule" could contain Full Time, 80 Hours Per Pay Period, Day Shift.
We must not create sections with filler like "not specified". Ensure we only include if content present.
Let's extract content.
Covenant Health Overview paragraph: "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 paragraph: "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 of 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. 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."
That's a long paragraph with many responsibilities. We can break into bullet list for responsibilities.
Minimum Education etc: "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."
We need to extract requirements: Education: high school diploma or GED preferred. Experience: 1-2 years healthcare preferred. Computer experience required. Knowledge of medical terminology, claims submission, customer service preferred. Must be familiar with insurance plans and requirements and collection practices (Fair Debt Credit and Collection Act). Expected to perform adequately after 3-6 months on the job.
Licensure: None.
Skills: Could list knowledge of medical terminology, claims submission, customer service, computer experience, understanding of payer requirements, HIPAA, HCFA, TennCare, state/federal regulations, ERA, 835 codes, etc. But we should not invent; we can pull from text.
We need to avoid duplication. Let's structure:
About the role: combine Covenant Health Overview and Position Overview? Might be too long but okay as prose.
Better: About the role: Covenant Health Overview (paragraph). Position Overview could be part of Responsibilities? But Position Overview includes many responsibilities; we can treat as responsibilities.
Thus About the role: just Covenant Health Overview.
Responsibilities: bullet list of duties from Position Overview (the long paragraph). We'll need to split into sensible bullet items.
Requirements: education, experience, licensure.
Skills: knowledge of medical terminology, claims submission, customer service, computer experience, understanding of payer requirements, HIPAA, HCFA, TennCare, state/federal regulations, ERA, 835 codes, ability to handle varying tasks, communication skills, etc.
Schedule: Full Time, 80 Hours Per Pay Period, Day Shift.
We must not include Benefits or Pay.
Now produce HTML fragment with
headings and
or
- .
We must not include markdown fences.
Let's craft.
First, About the role:
About the role
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.
Second, Responsibilities:
Responsibilities
- Demonstrates expanded knowledge of the billing requirements for UB and 1500 claims for acute care facilities and professional services.
- Coordinates daily workflow for accurate submission of insurance claims to payers to ensure timely reimbursement.
- Provides support and assistance to Medical Biller I for solving complex medical claim issues.
- Demonstrates ability to accurately submit claims in all payer categories (Medicare, TennCare, Blue Cross, Commercial, Managed Care).
- Assists Billing Coordinator, Billing Supervisors and Manager.
- Coordinates and prioritizes daily responsibilities including evaluating complex errors on medical claims with understanding of billing process and reimbursement.
- Ensures accuracy of UB and 1500 medical claim information by evaluating, recognizing, and resolving issues related to complex medical claims.
- Resolves complex patient and insurance information pre‑bill as identified on daily failed bill reports from the patient accounting system.
- Analyzes claim edits within billing system and payer sites for issues such as improper match of diagnosis, revenue codes, modifiers, charging units, physician’s NPI, and HCPCS/CPT codes.
- Identifies trends and investigates root cause of errors.
- When indicated, provides supporting medical records documentation for rejected, denied, 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 ensure appropriate reimbursement.
- Demonstrates enhanced understanding of payer’s electronic transaction advice (ERA) and claim rejection and denial codes (835) to determine appropriate actions for resolution and secondary billing processes.
- Assists Billing Supervisor to recognize and identify issues pertaining to the working of accounts.
- Handles varying tasks and understands/interprets 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 to assure departmental compliance.
- Recognizes situations necessitating supervision and guidance, seeks appropriate resources.
- Understands payer requirements of insurance carriers.
- Understands all patient information from facilities and specifics of each follow‑up to ensure appropriate reimbursement.
- 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
for prose. We need to preserve all substantive information, not invent or summarize away detail. Remove boilerplate etc. We need to include sections only when posting has real specific content. Thus sections: About the role (maybe combine Covenant Health Overview and Position Overview?), Responsibilities, Requirements (or Qualifications), Skills, Schedule. We need to decide headings: "About the role" could contain overview of Covenant Health and position overview. "Responsibilities" list duties. "Requirements" could contain minimum education, experience, licensure. "Skills" could contain knowledge of medical terminology, claims submission, computer experience, etc. "Schedule" could contain Full Time, 80 Hours Per Pay Period, Day Shift. We must not create sections with filler like "not specified". Ensure we only include if content present. Let's extract content. Covenant Health Overview paragraph: "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 paragraph: "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 of 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. 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." That's a long paragraph with many responsibilities. We can break into bullet list for responsibilities. Minimum Education etc: "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." We need to extract requirements: Education: high school diploma or GED preferred. Experience: 1-2 years healthcare preferred. Computer experience required. Knowledge of medical terminology, claims submission, customer service preferred. Must be familiar with insurance plans and requirements and collection practices (Fair Debt Credit and Collection Act). Expected to perform adequately after 3-6 months on the job. Licensure: None. Skills: Could list knowledge of medical terminology, claims submission, customer service, computer experience, understanding of payer requirements, HIPAA, HCFA, TennCare, state/federal regulations, ERA, 835 codes, etc. But we should not invent; we can pull from text. We need to avoid duplication. Let's structure: About the role: combine Covenant Health Overview and Position Overview? Might be too long but okay as prose. Better: About the role: Covenant Health Overview (paragraph). Position Overview could be part of Responsibilities? But Position Overview includes many responsibilities; we can treat as responsibilities. Thus About the role: just Covenant Health Overview. Responsibilities: bullet list of duties from Position Overview (the long paragraph). We'll need to split into sensible bullet items. Requirements: education, experience, licensure. Skills: knowledge of medical terminology, claims submission, customer service, computer experience, understanding of payer requirements, HIPAA, HCFA, TennCare, state/federal regulations, ERA, 835 codes, ability to handle varying tasks, communication skills, etc. Schedule: Full Time, 80 Hours Per Pay Period, Day Shift. We must not include Benefits or Pay. Now produce HTML fragment with
headings and
or
- .
We must not include markdown fences.
Let's craft.
First, About the role:
About the role
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.
Second, Responsibilities:Responsibilities
- Demonstrates expanded knowledge of the billing requirements for UB and 1500 claims for acute care facilities and professional services.
- Coordinates daily workflow for accurate submission of insurance claims to payers to ensure timely reimbursement.
- Provides support and assistance to Medical Biller I for solving complex medical claim issues.
- Demonstrates ability to accurately submit claims in all payer categories (Medicare, TennCare, Blue Cross, Commercial, Managed Care).
- Assists Billing Coordinator, Billing Supervisors and Manager.
- Coordinates and prioritizes daily responsibilities including evaluating complex errors on medical claims with understanding of billing process and reimbursement.
- Ensures accuracy of UB and 1500 medical claim information by evaluating, recognizing, and resolving issues related to complex medical claims.
- Resolves complex patient and insurance information pre‑bill as identified on daily failed bill reports from the patient accounting system.
- Analyzes claim edits within billing system and payer sites for issues such as improper match of diagnosis, revenue codes, modifiers, charging units, physician’s NPI, and HCPCS/CPT codes.
- Identifies trends and investigates root cause of errors.
- When indicated, provides supporting medical records documentation for rejected, denied, 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 ensure appropriate reimbursement.
- Demonstrates enhanced understanding of payer’s electronic transaction advice (ERA) and claim rejection and denial codes (835) to determine appropriate actions for resolution and secondary billing processes.
- Assists Billing Supervisor to recognize and identify issues pertaining to the working of accounts.
- Handles varying tasks and understands/interprets 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 to assure departmental compliance.
- Recognizes situations necessitating supervision and guidance, seeks appropriate resources.
- Understands payer requirements of insurance carriers.
- Understands all patient information from facilities and specifics of each follow‑up to ensure appropriate reimbursement.
- 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