Claims Processor I - Remote

Medical University of South Carolina • Charleston, SC

302d • Remote

About The Position

Under general supervision, the Claims Processor assures accurate and timely insurance claim production and processing, including both resolving EDI claim edits and preparing paper claims for submittal/mailing. Resolve denied/unpaid insurance claims in a timely manner.

Requirements

• High school diploma required.
• One year of billing and insurance follow up in a hospital or physician office setting preferred.
• General working knowledge of insurance terminology and billing rules.
• Able to prioritize work on a daily basis.
• Requires independent judgement in handling patient accounts.
• Direct supervision available on a daily basis as conditions may require.
• Knowledge of Epic preferred.

Responsibilities

• Account maintenance: Updating registration, authorization issues, identifying charge correction, debit or credit memos, processing adjustments as needed and denial follow up according to payer rules and departmental policies.
• Use electronic billing system appropriately to follow up on outstanding denied claims and all no response claims.
• Correct claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and place account on hold if unable to resolve.
• Follow up on denied or no response claims by calling third party payers or using payer websites.
• Gather information from patients or other areas to resolve outstanding denied or no response claims.
• Research accounts to take appropriate action necessary to resolve.
• Keep management aware of issues and trends to enhance operations and escalate slow-pay issues to managerial level when necessary.
• Use payer websites to stay current on payer rules and changes.
• Maintain 90% quality standards on account follow and activity.
• Maintain productivity standard as set forth by management team.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Educational Services
• Education Level: High school or GED