TennCare Billing Specialist (Contract) - hybrid Nashville, Tennessee

Position Summary

The Tennessee Department of Health, Division of Laboratory Services is seeking a contract employee to support the TennCare Billing Program.

The primary responsibility of this position is to maintain uninterrupted TennCare billing operations while supporting the Division's efforts to improve billing processes and prepare for implementation of a future modernized and automated billing solution.

The successful candidate will support billing activities from initial encounter preparation through reconciliation while identifying opportunities to improve efficiency, reduce manual effort, strengthen internal controls, and improve revenue cycle performance. The position will work closely with laboratory billing staff, fiscal administration, procurement, informatics, and external stakeholders to ensure accurate billing operations and support long-term modernization efforts.

This position is expected to continue through November 30, 2027, contingent upon funding availability.

Primary Responsibilities

TennCare 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.

Revenue Cycle Support and Issue Resolution (approximately 20%)

· 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.

Billing Process Improvement (approximately 20%)

· 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 Abilities

Preferred 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

Experience with any of the following is preferred but not required:

· PTBMIS

· StarLIMS

· Availity

· Tennessee Medicaid (TennCare)

· Healthcare billing software

· State government financial processes

Desired Qualifications

· 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.

Work Schedule

This position is expected to work:

· Monday-Friday

· Standard business hours (8:00 AM-4:30 PM with one-hour lunch)

This position is primarily onsite during the initial training period due to the complexity of the billing systems and required collaboration with the billing team. Following successful completion of training and demonstration of independent proficiency, the position may be eligible for a hybrid work schedule in accordance with Tennessee Department of Health policies and business needs.

Requirements