About This Role
The Billing Specialist is responsible for managing billing operations, supporting the revenue cycle, and identifying opportunities for process improvement. This role involves accurate data entry, payment reconciliation, and ensuring compliance with confidentiality standards.
Responsibilities
- Key TennCare encounters into PTBMIS accurately and within established timelines
- Post payments, write-offs, and maintain revenue tracking
- Update billing addresses and maintain provider information
- Maintain HIPAA compliance and confidentiality standards
- Prepare monthly billing reports and supporting documentation
- Provide operational billing support to ensure continuity of services
- Research billing discrepancies, payment issues, claim denials, and reconciliation differences
- Identify root causes of billing errors and recommend corrective actions
- Review billing trends and identify recurring issues impacting reimbursement
- Document manual workarounds and standard operating procedures
- Perform reconciliations between billing activity, remittances, and financial reports
- Monitor billing timelines to support timely filing requirements
- Evaluate current billing workflows and identify opportunities for automation
- Support implementation planning for a future third-party billing solution
- Participate in workflow mapping and documentation
- Plan, coordinate, and execute testing, validation, and documentation for new billing processes, system enhancements, and future third-party billing solutions
- Recommend efficiencies that reduce manual data entry and duplicate work
- Develop and maintain process documentation and training materials
- Participate in special projects supporting modernization of laboratory billing operations
- Collaborate with laboratory staff, fiscal administration staff, procurement, informatics, and external stakeholders to resolve billing issues and support billing process improvements
Requirements
- Experience with medical billing, Medicaid, or healthcare revenue cycle operations
- Experience with claims processing or encounter management
- Microsoft Excel (intermediate level)
- Experience investigating billing discrepancies
- Experience with process improvement or workflow analysis
- Experience with data validation and quality assurance
- Experience maintaining confidential health information (HIPAA)
- Ability to learn multiple software systems
- Ability to follow detailed written procedures
- Ability to work independently while managing competing priorities