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Job Description Job Description Reimbursement Specialist - Insurance Verification (UTMC Program) Help Others, Make a Difference, Save a Life. Do you want to make a difference in people's lives every day? Or help people navigate the tough spots in their life? And do it all while working where your hard work is appreciated? You have a lot of choices in where you work make the decision to work where you are valued! Join the McNabb Center Team as the Reimbursement Specialist - Insurance Verification (UTMC Program) today! The Reimbursement Specialist - Insurance Verification (UTMC Program) JOB SUMMARY The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance. Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate. The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions. Will be required to work regular office hours at the designated facility. JOB DESCRIPTION Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information. JOB DUTIES/RESPONSIBILITIES NOTE: The job duties listed are typical duties of the work performed. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty. Reviews the center's Commercial Notification Forms and returns an Insurance Verification Forms to the requesting staff within designated program timeframe. Verifies insurance information is up to date for the next day's client roster and updates any applicable pop-ups in the system For new clients, gives contact information, obtain client photo, updates the EMR with correct information and ensures the appropriate intake packet paperwork has been signed and verified to ensure clients understanding of policies. Prepares and updates the designated facility facesheets with insurance issues, patient responsibilities, outstanding balances, and any non-payment status changes for the next day and places them in HIPAA compliant blue folders for the appropriate providers. Analyzes designated eligibility reports on a daily basis. Communicates with and advises Insurance Verification Team Leader of all problems related to insurance verification. Advises other departments of updated or new insurance information as needed. Adheres to all policies and procedures related to compliance with all federal and state billing regulations. Communicates with billing representatives regarding any insurance issues that may arise. Review and update the Non-Payment status documents for both Med appointments and Therapy appointments Maintains a positive and professional attitude. Reads all emails and responds accordingly in a timely manner. Listens to all voicemails and responds accordingly in a timely manner. Works with members of various teams and/or departments on identifying process improvements. Possess flexibility to work overtime as dictated by department/organization needs. Communicates with clients regarding any benefit and/or billing questions they may have. Performs specified client benefit duties to ensure all required information is obtained for insurance verification, billing, and claims follow-up. Collects all client responsibility balances via cash, check, money order or credit card and issues receipts for payments. Assists in determining proper courses of action for successful resolution to insurance issues. Completes all program related paperwork required for reporting purposes. Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections. Reviews patient bills for accuracy and completeness and obtains any missing information. Sets up patient payment plans and works collection accounts. Submits monthly recommendations to supervisor for write-offs with complete documentation by first of the following month all while following the A/R Reference Guide on how to complete write offs. Performs additional duties as requested by Team Leads or Management Team. This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment. JOB QUALIFICATIONS Advanced use of computer system software, Excel, Outlook and Microsoft (word processing and spreadsheet application). Knowledge of insurance guidelines for all Commercial, Medicare, Medicare Advantage, TennCare, Federal Medicaid and Private Pay financial classes. Exceptional customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds. Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems. Strong written and verbal communication skills. Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Maintain a good understanding of the state, federal, and payer guidelines on billings, collections, refunds, and overpayments. Knowledge of the center's Policies and Procedures. Ability to maintain records and prepare reports and correspondence related to the position. Ability to work directly with upper leadership regarding claims issues and resolutions. Possess effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others. COMPENSATION: Starting salary for this position is approximately $19.54/hr based on relevant experience and education. Schedule: Monday - Friday 8am - 5pm Travel : N/A Equipment/Technical Competency : Advanced use of computer system software, Excel, Outlook and Microsoft (word processing and spreadsheet application). QUALIFICATIONS - Reimbursement Specialist - Insurance Verification (UTMC Program) Experience: Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties. Education / License : High school diploma or equivalent required. Location: Knox County, Tennessee Apply today to work where we care about you as an employee and where your hard work makes a difference! Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment. Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply. Compensation details: 19.54-19.54 Hourly Wage PI73f2ce5-

Job Description Job Description Help Others, Make a Difference, Save a Life. Do you want to make a difference in people's lives every day? Or help people navigate the tough spots in their life? And do it all while working where your hard work is appreciated? You have a lot of choices in where you work make the decision to work where you are valued! Join the McNabb Center Team as the Reimbursement Specialist program today! The Reimbursement Specialist JOB SUMMARY The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance. Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate. The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions. Will be required to work regular office hours at the designated facility. This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment. JOB DESCRIPTION Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information. JOB DUTIES NOTE: The job duties listed are typical duties of the work performed. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty. Analyzes designated eligibility reports on a daily basis. Communicates with and advises Insurance Verification Team Leader of all questions problems related to insurance verification. Adheres to all policies and procedures related to compliance with all federal and state billing regulations. Communicates with billing representatives regarding any insurance issues that may arise. Maintains a positive and professional attitude. Reads all emails and responds accordingly in a timely manner. Listens to all voicemails and respond accordingly in a timely manner. Works with members of various teams and/or departments on identifying process improvements. Possess flexibility to work overtime as dictated by department/organization needs. Assists in determining proper courses of action for resolution to insurance issues. Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections. Possesses strong ability to think outside the box. Has the ability to work in a high stress/demanding environment. Performs additional duties as requested by Team Leads or Management Team. JOB QUALIFICATIONS Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). Knowledge of Centricity is a strong plus. Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid and Private Pay. Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems. Strong written and verbal communication skills. Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Knowledge of the center's Policies and Procedures. Ability to maintain records and prepare reports and correspondence related to the position. Ability to work directly with upper leadership regarding claims issues and resolutions. Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others. JOB EXPECTATION All employees must be clean and well-groomed. Styles dictated by religion and ethnicity aren't restricted. Business casual dress code required. Employees can use their phones during breaks or at lunch hour. Employee must observe and be respectful of co-workers and should never use obscene, discriminatory, offensive, prejudicial or defamatory language in any way. The use of cameras on cell phones during work time is prohibited to protect the privacy of the clients as well as fellow employees, unless permission is granted by fellow employees or managers. Employees are permitted two 15-minute breaks and one hour lunch. Employees must work the agreed upon work schedule. Enter hours worked daily. Request leave in advance to your supervisor for approval. Schedule: Monday - Friday 8am - 5pm Travel : N/A Equipment/Technology : Basic computer skills are required for email, timekeeping, scanning, and fax machine. Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). QUALIFICATIONS - Reimbursement Specialist Education: High school diploma or equivalent required. Experience / Knowledge : Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties. Location: Knoxville, Tennessee Apply today to work where we care about you as an employee and where your hard work makes a difference! Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment. Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply. PI0b5c1283dd27-1027

Job Description Job Description SUMMARY: The Revenue Cycle Specialist is responsible for researching, correcting, resubmitting, and resolving medical claims that have been rejected, denied, underpaid, or otherwise not processed correctly by insurance payers. This position focuses on identifying the causes of claim issues, coordinating necessary corrections with internal departments and external payers, and following claims through to resolution. The Medical Billing Specialist works closely with the Billing Technician, Business Office Manager, providers, coding staff, clinical departments, and insurance representatives to resolve billing issues, reduce preventable denials, and support appropriate reimbursement for services provided by the Health Center. ESSENTIAL DUTIES AND RESPONSIBILITIES will include the following: Electronic Clearinghouse Rejections Monitor the designated electronic clearinghouse for rejected claims, submission errors, and other claim transmission issues. Review and address electronic clearinghouse rejections promptly upon receipt. Research rejection reasons and determine the appropriate corrective action. Correct and resubmit claims when issues can be resolved within the scope of the position. Coordinate with the Billing Technician, registration, coding staff, providers, or other departments when additional information or corrections are required. Document rejection reasons, actions taken, outstanding issues, and follow-up plans. Monitor unresolved rejections until corrected and resubmitted or otherwise appropriately resolved. Ensure no rejection remains unaddressed or without documented follow-up. Denied Claims and Corrected Claim Submission Review remittance advice, explanations of benefits (EOBs), denial reports, and claim status information to identify denied or incorrectly processed claims. Research denial codes, payer explanations, claim history, billing requirements, and supporting documentation to determine the reason for denial. Correct claim information and coordinate necessary documentation or coding clarification. Prepare and submit corrected claims, resubmissions, reconsiderations, and appeals as appropriate. Verify that corrections address the original rejection or denial reason before resubmission. Track corrected claims to confirm receipt and monitor payer processing. Maintain documentation of denial reasons, corrective actions, resubmission dates, payer responses, and outcomes. Escalate claims requiring management review, clinical clarification, or additional intervention. Denial Research and Resolution Investigate recurring and complex denials to identify root causes and prevent repeated billing errors. Research payer policies, eligibility issues, authorization requirements, filing limits, coding requirements, and documentation requirements relevant to denied claims. Contact insurance representatives and use payer portals to clarify denial reasons, claim status, payment decisions, and required corrective actions. Coordinate with providers, coding staff, and clinical departments to obtain missing or corrected information. Prepare and submit appeals or reconsideration requests within applicable payer deadlines when appropriate. Monitor appealed claims until a determination is received. Identify recurring denial trends and report significant issues to the Business Office Manager. Unpaid and Incorrectly Processed Claims Research unpaid, pending, underpaid, and incorrectly processed claims to determine the cause and appropriate resolution. Follow up with payers regarding claims that remain unpaid or have not been processed correctly. Review discrepancies between billed amounts, payer adjudication, remittance advice, and expected reimbursement. Determine whether claim correction, resubmission, additional documentation, reconsideration, or appeal is appropriate. Monitor claims approaching timely filing limits, appeal deadlines, and other payer-specific timeframes. Maintain a tracking system documenting claim status, actions taken, outstanding issues, and follow-up dates. Escalate unresolved claims with significant financial impact or barriers to resolution to the Business Office Manager. Continue follow-up until the claim is resolved, appropriately escalated, or closed with documented justification. Prior Authorization-Related Claim Issues Research claim denials related to missing, incomplete, expired, or mismatched prior authorizations. Coordinate with appropriate clinical or administrative staff to obtain authorization information or supporting documentation. Communicate authorization-related claim issues to the responsible department. Monitor corrected claims related to authorization issues to determine whether the payer has processed them. Document actions taken and escalate unresolved issues as appropriate. This responsibility focuses on authorization issues affecting claim payment. Routine prior authorization requests remain with designated staff unless otherwise assigned. Documentation and Process Improvement Maintain accurate records of rejections, denials, corrected claims, appeals, payer communications, and resolution efforts. Ensure unresolved items have documented actions, next steps, and follow-up dates. Coordinate with the Billing Technician and other departments to address recurring claim issues. Identify opportunities to reduce preventable rejections and denials and improve claim resolution. Assist with billing reviews, payer audits, and quality improvement activities as assigned. Maintain knowledge of payer policies, claim correction procedures, appeal requirements, and applicable billing guidelines. Confidentiality and Compliance Protect patient confidentiality and the security of health records and other confidential information. Comply with applicable privacy and security laws, including HIPAA and the Privacy Act of 1974 when applicable, and Health Center policies. Follow applicable payer requirements and established Health Center procedures. Perform other related duties within the scope of the position as assigned by the Business Office Manager. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform the essential duties satisfactorily. The requirements listed below represent the knowledge, skills, and abilities needed for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. EDUCATION AND EXPERIENCE: Associate of Arts (AA) degree or at least two (2) years of relevant work experience in medical billing, healthcare administration, insurance claims processing, accounts receivable, or a related field. Ability to research billing issues, identify errors, follow established procedures, and complete corrective actions accurately and promptly. Strong attention to detail and ability to organize work, meet deadlines, maintain accurate documentation, and communicate effectively with internal departments and insurance payers. Ability to learn and apply insurance payer requirements, claim correction procedures, and denial resolution processes. Experience reviewing electronic clearinghouse rejections, insurance denials, and payment discrepancies. Experience correcting and resubmitting claims, researching unpaid claims, or assisting with appeals and reconsiderations. Familiarity with electronic clearinghouses, payer portals, electronic health records, or practice management systems. Knowledge of Medicare, Medicaid, commercial insurance, managed care plans, and payer billing requirements. Familiarity with ICD-10-CM, CPT, and HCPCS coding concepts. Medical billing certification, such as Certified Professional Biller (CPB), or medical coding certification, such as Certified Professional Coder (CPC). Experience working in a Tribal Health, Indian Health Service (IHS), community health center, or similar healthcare setting. CERTIFICATES, LICENSES, AND/OR REGISTRATIONS: Medical billing or coding certification is preferred but not required. KNOWLEDGE, SKILLS, AND ABILITIES: Ability to research and resolve claim rejections, denials, and billing discrepancies. Ability to learn payer-specific correction, resubmission, reconsideration, and appeal requirements. Strong organizational, analytical, and problem-solving skills. Effective written and verbal communication skills. Ability to recognize recurring billing issues and communicate potential solutions. Ability to maintain accurate records and protect confidential patient information. Proficiency with standard computer applications, including Microsoft Word and Excel, and the ability to learn designated billing systems and electronic clearinghouse tools. Ability to work independently, manage competing priorities, meet deadlines, and seek assistance when necessary. Ability to coordinate professionally with internal departments and external insurance representatives. PLEASE NOTE: P.L. 93-638, Indian Preference and Tribal Employment Rights Ordinance, (TERO), will be practiced, however all qualified applicants will be considered. IF YOU ARE INTERESTED . click apply for full job details

Help Others, Make a Difference, Save a Life. Do you want to make a difference in people's lives every day? Or help people navigate the tough spots in their life? And do it all while working where your hard work is appreciated? You have a lot of choices in where you work make the decision to work where you are valued! Join the McNabb Center Team as the Reimbursement Specialist program today! The Reimbursement Specialist JOB SUMMARY The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance. Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate. The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions. Will be required to work regular office hours at the designated facility. This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment. JOB DESCRIPTION Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information. JOB DUTIES NOTE: The job duties listed are typical duties of the work performed. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty. Analyzes designated eligibility reports on a daily basis. Communicates with and advises Insurance Verification Team Leader of all questions problems related to insurance verification. Adheres to all policies and procedures related to compliance with all federal and state billing regulations. Communicates with billing representatives regarding any insurance issues that may arise. Maintains a positive and professional attitude. Reads all emails and responds accordingly in a timely manner. Listens to all voicemails and respond accordingly in a timely manner. Works with members of various teams and/or departments on identifying process improvements. Possess flexibility to work overtime as dictated by department/organization needs. Assists in determining proper courses of action for resolution to insurance issues. Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections. Possesses strong ability to think outside the box. Has the ability to work in a high stress/demanding environment. Performs additional duties as requested by Team Leads or Management Team. JOB QUALIFICATIONS Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). Knowledge of Centricity is a strong plus. Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid and Private Pay. Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems. Strong written and verbal communication skills. Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Knowledge of the center's Policies and Procedures. Ability to maintain records and prepare reports and correspondence related to the position. Ability to work directly with upper leadership regarding claims issues and resolutions. Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others. JOB EXPECTATION All employees must be clean and well-groomed. Styles dictated by religion and ethnicity aren't restricted. Business casual dress code required. Employees can use their phones during breaks or at lunch hour. Employee must observe and be respectful of co-workers and should never use obscene, discriminatory, offensive, prejudicial or defamatory language in any way. The use of cameras on cell phones during work time is prohibited to protect the privacy of the clients as well as fellow employees, unless permission is granted by fellow employees or managers. Employees are permitted two 15-minute breaks and one hour lunch. Employees must work the agreed upon work schedule. Enter hours worked daily. Request leave in advance to your supervisor for approval. Schedule: Monday - Friday 8am - 5pm Travel : N/A Equipment/Technology : Basic computer skills are required for email, timekeeping, scanning, and fax machine. Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). QUALIFICATIONS - Reimbursement Specialist Education: High school diploma or equivalent required. Experience / Knowledge : Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties. Location: Knoxville, Tennessee Apply today to work where we care about you as an employee and where your hard work makes a difference! Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment. Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply. PIf5-