Healthcare Billing Specialist

Role: Healthcare Billing SpecialistDuration: 8 Months (Contract expected to extend)Location: Nashville, TN (On-Site)Key Skills: Medical billing operations, Healthcare claims submission, Write-offs, reimbursement tracking, and billing documentation, Claims Reconciliation and Discrepancy Resolution, Data tracking, filtering, sorting, and validation, Validating billing transactions and payment recordsPrimary ResponsibilitiesTennCare Billing Operations (approximately 60%)

• 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.

• PTBMIS
• StarLIMS
• Availity
• Tennessee Medicaid (TennCare)
• Healthcare billing software
• State government financial processes

• Experience in healthcare billing, medical office administration, finance, laboratory operations, or related field.
• Strong analytical and problem-solving skills.
• Excellent organizational and time management abilities.
• Ability to identify process improvements and recommend practical solutions.
• Strong written and verbal communication skills.
• High attention to detail with demonstrated accuracy.
• Ability to maintain confidentiality and handle sensitive information.

• 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.

Knowledge, Skills, and AbilitiesPreferred candidates will have experience with:

• Medical billing, Medicaid, or healthcare revenue cycle operations
• Claims processing or encounter management
• Microsoft Excel (intermediate level)
• Investigating billing discrepancies
• Process improvement or workflow analysis
• Data validation and quality assurance
• Maintaining confidential health information (HIPAA)
• Learning multiple software systems
• Following detailed written procedures
• Working independently while managing competing priorities