Scotland Health Claims Document Submission Specialist

Scotland Health Care System in Laurinburg, North Carolina • Laurinburg, NC

24d • Onsite

About The Position

The Claims Document Submission Specialist is responsible for gathering, preparing, and submitting all necessary claim-related documents to insurance payers. This role ensures that documentation is complete, accurate, and compliant with payer requirements to avoid denials and facilitate timely payment. The specialist will manage documentation requests, track submissions, and collaborate with internal teams and external payers to resolve issues.

Requirements

• High School graduate
• Experience in claim follow-up, denials management, or appeals
• Knowledge of payer-specific documentation requirements
• Prior experience in hospital or physician billing environments
• Knowledge of healthcare revenue cycle processes and insurance claim workflows
• Familiarity with UB-04 and CMS-1500 claim forms
• Experience working with payer portals (e.g., Availity, NaviNet)
• Understanding of medical terminology and clinical documentation
• Strong attention to detail and organizational skills
• Ability to manage multiple requests and deadlines simultaneously
• Proficient in electronic medical record (EMR) systems

Nice To Haves

• Associate’s degree in Healthcare Administration, Medical Office Technology, or a related field

Responsibilities

• Gather all necessary claim-related documents, including medical records, physician notes, operative reports, referral forms, prior authorizations, itemized bills, UB-04, and CMS-1500 claim forms.
• Review documentation for completeness, accuracy, and payer compliance before submission.
• Upload and submit required documentation through payer portals such as Availity, NaviNet, and other payer-specific websites or electronic portals.
• Ensure correct association of documents with corresponding claims and patient accounts.
• Ensure timely submission to avoid timely filing denials.
• Communicate with insurance representatives as needed.
• Troubleshoot claim issues related to documentation.
• Track documentation requests from insurance payers related to medical necessity reviews, pre-payment audits, claim denials, appeals, and reconsiderations.
• Monitor submission deadlines and ensure timely responses to avoid claim delays or denials.
• Verify that submissions comply with payer-provider guidelines, HIPAA regulations, and internal policies.
• Maintain detailed records of all documents submitted, including submission dates and confirmation numbers.
• Collaborate with coding, billing, utilization review, and clinical staff to obtain missing or clarifying documentation.
• Communicate with payers as needed to resolve documentation issues or confirm receipt.

Benefits

• Competitive compensation
• Family-friendly benefits including Paid Parental Leave and On-Site Childcare
• Flexible scheduling
• Exclusive savings programs
• Career growth and advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED