Billing Specialist

We are seeking a detail-oriented TennCare Billing Specialist in Nashville, TN. This role maintains uninterrupted TennCare billing operations, processes medical encounters, reconciles payments, and supports long-term revenue cycle modernization. The specialist will work closely with laboratory billing staff, fiscal administration, informatics, and vendor partners to improve billing workflows, eliminate manual redundancies, and prepare for a modernized third-party billing platform.

Location: 630 Hart Lane, Nashville, TN 37216

Work Arrangement: Hybrid (On-site required during initial system training; eligible for hybrid work upon demonstrating independent system proficiency)

Residency Requirement: Candidate MUST be a current resident of Tennessee (or established resident in the local service area prior to start)

Role Type: Contract (11/09/2026 – 06/30/2027; Position expected to continue through November 30, 2027, contingent on funding)

Interview Process: Web Cam or In-Person Interview

Shift / Schedule: Monday – Friday, 8:00 AM – 4:30 PM CST (37.5 hours per week)

Background Verification: Requires standard state background verification (7-year criminal history, statewide county search, sex offender registry, global watch).

Key Responsibilities

• TennCare Billing Operations (60%): Key TennCare medical encounters into PTBMIS accurately and within strict filing deadlines; post payments and write-offs; maintain provider profiles; prepare monthly billing and revenue tracking reports.
• Revenue Cycle Support & Issue Resolution (20%): Research claim denials, billing discrepancies, and remittance differences; analyze root causes of billing errors; document manual workarounds and perform routine financial reconciliations.
• Billing Process Improvement & Modernization (20%): Evaluate laboratory billing workflows to identify automation opportunities; support system testing and user validation for future third-party billing platforms; update standard operating procedures (SOPs) and training guides.
• Compliance & Stakeholder Coordination: Maintain HIPAA data privacy standards; collaborate with laboratory staff, fiscal administration, procurement, informatics, and external state clearinghouses.

Required & Desired Qualifications

• Healthcare Billing & Revenue Cycle: Experience in medical billing, Medicaid/TennCare claims processing, healthcare revenue cycle operations, or laboratory office administration.
• Financial Reconciliation & Bookkeeping: Demonstrated proficiency in balancing/reconciling billing accounts, remittances, and ledger entries (4–6 years experience).
• Data Entry & Accuracy: 4–6 years of high-volume, accurate data entry, typing, and customer service.
• Software & Spreadsheets: Intermediate-to-advanced proficiency with Microsoft Excel (data validation, formulas, tracking reports) and healthcare billing systems.
• Process Improvement & QA: Experience investigating billing discrepancies, mapping workflows, and executing software testing/validation.
• Tennessee Residency: Must be a current resident of the State of Tennessee residing within the local service area.

Preferred Systems Experience

• Hands-on experience with state or laboratory billing systems, including PTBMIS, StarLIMS, Availity, or TennCare Medicaid billing platforms.
• Knowledge of state government financial and procurement processes.