Medical Biller I, CMG Business Office

Responsibilities

• Provides clerical and administrative support for the billing team.
• 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.
• Identifies 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.
• 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.
• Accurately processes practice management system transactions related to resolution of open accounts including but not limited to adjustments, transfer of payments, and refunds.
• Interprets insurance explanation of benefits and its application when reviewing patient accounts.
• Works toward achieving department goals and objectives. Participates in quality improvement initiatives as requested.

Qualifications

• Minimum Education: High School Diploma or equivalent.
• Minimum Experience: One (1) to two (2) years of experience in healthcare revenue cycle required (i.e., medical billing, insurance/percert verification, registration, Health Information Management (HIM), coding, claims management/insurance follow-up or appeals, etc.).
• Licensure Requirement: None.