Claim Dispute Representative

Summit Medical Group, P.L.L.C. - Knoxville, TN (30+ days ago)2.3


About Summit Medical Group

Summit Medical Group is East Tennessee’s largest primary care organization with more than 300 providers at 60 practice locations in 14 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, three express clinics, central laboratory and sleep services center. Summit provides healthcare services to more than 260,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com.

.In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program. Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Furthermore, Summit Medical Group hires only non-tobacco users. Pre-employment drug testing will include testing for nicotine, and only candidates who pass the drug test will be considered eligible for employment.

About Our Career Opportunity

Summit Strategic Solutions has a need for an Claims Dispute Representative at its Central Billing Office to identify, investigate and resolve billing issues with patients accounts. This position in full time, flexible working hours (at managers's discretion) Monday-Friday. This position allows casual dress code. (specific details discussed in interview)

EXAMPLES OF DUTIES: (List does not include all duties assigned)

Investigates insurance claim denials and formulates solutions with a primary focus on Medicare, Medicaid and Tenncare products.
Assists in maintaining, updating and auditing the patient account information.
Transfers charges to the correct agency or carrier, when appropriate.
Communicates with insurance companies and patients as needed.
Adjusts patient accounts according to established policies and procedures.
Communicates appropriate problems, questions and / or concerns to supervisor.
Assists colleagues in department and other office personnel, as appropriate.
Displays initiative, when appropriate, while investigating insurance pending reports and handling other assignments.
Adheres to all elements of the established corporate compliance plan.
Maintains strictest confidentiality both internally and externally.
Performs related work as assigned.
Knowledge of medical terminology, ICD-9, ICD-10 and CPT coding.
Skill in data entry, processing, and computer skills.
Knowledge of basic spelling, grammar and punctuation to process patient information.
Ability to apply policies and principles to solve everyday problems and deal with a variety of situations.
Ability to work effectively with physicians, patients, staff and the public.
Ability to establish priorities and coordinate work activities.
EDUCATION: High School Diploma or GED required.

EXPERIENCE: Minimum of 2 years in medical billing required. Experience with Medicare, Medicaid and Tenncare products preferred.

.PERFORMANCE REQUIREMENT: Knowledge, Skills and Abilities

  • Knowledge of medical terminology, ICD-9, ICD-10 and CPT coding.
  • Skill in data entry, processing, and computer skills.
  • Knowledge of basic spelling, grammar and punctuation to process patient information.
  • Ability to apply policies and principles to solve everyday problems and deal with a variety of situations.
  • Ability to work effectively with physicians, patients, staff and the public.
  • Ability to establish priorities and coordinate work activities.