Claim Processor-1

Medical University of South Carolina•Remote- South Carolina, SC

2d•Onsite

About The Position

Under general supervision, this role assures accurate and timely insurance claim processing, including resolving claim edits and paper claims for submittal. The Claim Processor is responsible for resolving denied/unpaid insurance claims in a timely manner. This position involves account maintenance, such as updating registration, handling authorization issues, identifying charge corrections, processing adjustments, and following up on denials according to payer rules and departmental policies. The role requires the appropriate use of an electronic billing system to follow up on outstanding denied and no-response claims, correcting claims with missing or invalid information, and placing accounts on hold if resolution is not possible. The Claim Processor will also follow up on denied or no-response claims by contacting third-party payers or using payer websites, gathering necessary information from patients or other departments, and researching accounts to take appropriate action. This role requires keeping management informed of issues and trends to enhance operations and escalating slow-pay issues when necessary. Staying current on payer rules and changes by using payer websites, reading newsletters, and communicating payer/claim issues and trends is essential. The position requires maintaining 95% quality standards on account follow-up and activity, as well as meeting productivity standards set by the management team. Other duties as assigned.

Requirements

High School Degree or Equivalent
0-6 months of work experience

Responsibilities

Assures accurate and timely insurance claim processing.
Resolves claim edits and paper claims for submittal.
Resolves denied/unpaid insurance claims in a timely manner.
Performs account maintenance, including updating registration, handling authorization issues, identifying charge corrections, and processing adjustments.
Follows up on denials according to payer rules and departmental policies.
Uses electronic billing system to follow up on outstanding denied and no-response claims.
Corrects claims in electronic billing system for missing or invalid insurance or patient information.
Places accounts on hold if claims cannot be resolved.
Follows up on denied or no-response claims by calling third-party payers or using payer websites.
Gathers information from patients or other areas to resolve outstanding denied or no-response claims.
Researches accounts to take appropriate action necessary to resolve.
Keeps management aware of issues and trends to enhance operations.
Escalates slow-pay issues to managerial level when necessary.
Uses payer websites to stay current on payer rules and changes.
Reads newsletters and communicates payer/claim issues and trends.
Maintains 95% quality standards on account follow and activity.
Maintains productivity standards as set forth by management team.
Performs other duties as assigned.