Medical Biller II

Covenant Medical Group is Covenant Health’s employed and managed medical practice organization, serving more than 300 physicians and providers across 20 cities in East Tennessee.

This role supports billing and follow-up functions for all financial class categories, including review, correction, submission, resubmission, and appeal of rejected, denied, unpaid, or improperly paid insurance claims. The position also provides patient customer service and releases billing records to approved entities.

Responsibilities include:

• Serving as a resource for Medical Biller Is on intermediate to complex account and claims issues
• Supporting Customer Service, Collections, and Payment Posting with eligibility, claims processing, and patient balance questions
• Submitting primary, secondary, and tertiary claims through clearinghouses, payer portals, and paper mail
• Reviewing rejected claims, making corrections, and processing rebills as needed
• Identifying medical and financial records needed to support claim filing
• Analyzing rejections and denials to determine root cause and resolve account issues
• Monitoring denial trends and reporting them appropriately
• Working with state and federal regulations, Medicare, TennCare, and other third-party payer requirements
• Interpreting CARC, RARC, payer policies, and denial language
• Preparing and submitting reconsiderations and appeals with supporting documentation
• Resolving overpayments, including recoupments, refunds, and transaction corrections
• Verifying plan eligibility, coordination of benefits, and plan participation using registration systems and payer websites
• Reviewing registration information and correcting deficiencies when possible
• Communicating with patients, payers, physicians, and internal departments in a professional manner
• Explaining claims processing, plan benefits, and account balances to patients
• Processing adjustments, payment transfers, and refunds in the practice management system
• Applying self-pay discounts and good faith estimate adjustments according to policy
• Following departmental policies, quality expectations, and required education