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Provider Enrollment Research Representative in Louisville, TN at TeamHealth

Date Posted: 6/17/2022

Job Snapshot

Job Description

TeamHealth is a physician-led, patient-focused company. Founded by doctors, for doctors, our success stems from the ingenuity, dedicated teamwork and integrity of our people. Our non-clinical associates are the ones that make TeamHealth tick. Whether you have your eye on the home office or one of our locations around the country, you can find your place here.

JOB DESCRIPTION OVERVIEW:

This position is responsible for reviewing remittances with Medicaid, Medicare, TennCare, Blue Cross Blue Shield denials at their assigned Billing Group.  Maintains accuracy and production to ensure remittances are being processed effectively.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Reviews EOB's and enters rejection codes, financial comments, and rebills claim as necessary.
  • Reviews denials to determine appropriate action based on carrier requirements.
  • Assembles and forwards documentation to appeal disputed claims.
  • Contacts Medicare, Medicaid, TennCare and Blue Cross Blue Shield to inquire on     unpaid claims in the Appeal 
  • Contacts Managed Care carriers to inquire on unpaid claims in the Appeal FSC.
  • Handles correspondence related to Medicaid, Medicare, TennCare, and Blue Cross Blue Shield according to written procedure.
  • Assembles and forwards appropriate documentation to the senior representative for provider related issues.
  • Reviews Medicaid, Medicare, TennCare, and Blue Cross Blue Shield provider manuals and updates.
  • Reports any consistent errors found during review that affect claims from being processed correctly.
  • Participates in unit progress meetings with Hospitalist Accounts Receivable Team.
  • Turns to supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
  • Performs any and all duties as directed by Senior Representative and Accounts Receivable Manager.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • High school diploma or equivalent required;
  • Previous medical billing experience preferred with primary emphasis on Government programs, such as Medicare, Medicaid, Indigent Care;
  • Excellent communication skills both oral and written;
  • Good computer skills;
  • Ability to meet deadlines;
  • Ability to work overtime as needed.

SUPERVISORY RESPONSIBILITIES:

  • None

 

PHYSICAL / ENVIRONMENTAL DEMANDS:

This job should be performed in a well-lighted and well-vented environment.  Requires constant sitting tolerance.  Extended amount of time spent in front of computer display terminal.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

 

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.