TennCare Billing Specialist (Contract)

Position Summary

The Tennessee Department of Health, Division of Laboratory Services, is seeking a contract TennCare Billing Specialist to maintain billing operations and support improvements ahead of a future modernized and automated billing solution. The role involves managing billing activities from encounter entry through payment posting and reconciliation while improving efficiency, strengthening internal controls, and supporting revenue cycle performance. The contract is expected to continue through November 30, 2027, contingent upon funding availability.

Key Responsibilities

TennCare Billing Operations (60%)

• Enter TennCare encounters accurately into PTBMIS within established timelines.

• Post payments and write-offs and maintain revenue tracking records.

• Update billing addresses and provider information.

• Prepare monthly billing reports and supporting documentation.

• Maintain HIPAA compliance and confidentiality standards.

• Provide day-to-day billing support to ensure uninterrupted operations.

Revenue Cycle Support and Issue Resolution (20%)

• Investigate billing discrepancies, payment issues, claim denials, and reconciliation differences.

• Identify root causes of billing errors and recommend corrective actions.

• Review billing trends and recurring issues affecting reimbursement.

• Reconcile billing activity, remittances, and financial reports.

• Monitor billing timelines to support timely claim filing.

• Document manual workarounds and standard operating procedures.

Billing Process Improvement (20%)

• Evaluate existing billing workflows and identify opportunities for automation and efficiency.

• Support planning for the implementation of a future third-party billing solution.

• Participate in workflow mapping, testing, validation, and documentation for new billing processes and system enhancements.

• Recommend ways to reduce manual data entry and duplicate work.

• Develop and maintain process documentation and training materials.

• Participate in modernization projects for laboratory billing operations.

• Collaborate with laboratory staff, fiscal administration, procurement, informatics, and external stakeholders to resolve issues and improve billing processes.

Required Knowledge, Skills, and Abilities

• Experience in medical billing, Medicaid, healthcare revenue cycle operations, or claims processing.

• Proficiency in Microsoft Excel at an intermediate level.

• Ability to investigate billing discrepancies and perform reconciliations.

• Knowledge of data validation, quality assurance, and workflow improvement.

• Understanding of HIPAA compliance and confidential health information handling.

• Ability to learn and navigate multiple software systems.

• Strong analytical, problem-solving, organizational, and time management skills.

• Excellent written and verbal communication skills.

• High attention to detail and accuracy.

• Ability to follow written procedures, work independently, and manage competing priorities.

Preferred Experience

• Experience with PTBMIS, StarLIMS, Availity, TennCare, or other healthcare billing software.

• Familiarity with state government financial processes.

• Background in healthcare billing, medical office administration, finance, laboratory operations, or a related field.

Work Schedule and Location

• Schedule: Monday–Friday, 8:00 AM–4:30 PM, with a one-hour lunch.

• Work Arrangement: Primarily onsite during initial training.

• Hybrid Eligibility: May be available after successful completion of training and demonstration of independent proficiency, subject to Tennessee Department of Health policies and business needs.