Claims Processor I - Remote

Medical University of South Carolina-posted 8 months ago
Full-time • Entry Level
Remote • Charleston, SC
Educational Services
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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.

  • 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.
  • 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.
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