Claims Processor I

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

5d•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 Claims Processor I 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, and processing adjustments as needed. It also includes denial follow-up according to payer rules and departmental policies. The role requires appropriate use of the electronic billing system to follow up on outstanding denied and no-response claims, correcting claims for missing or invalid information, and placing accounts on hold if resolution is not possible. Follow-up on denied or no-response claims is conducted by calling third-party payers or using payer websites, and gathering information from patients or other areas to resolve these claims. The Claims Processor I is expected to keep management informed of issues and trends to enhance operations and escalate 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 also a key responsibility. The role requires maintaining 95% quality standards on account follow 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, including resolving claim edits and paper claims for submittal.
Resolves denied/unpaid insurance claims in a timely manner.
Performs account maintenance: Updating registration, authorization issues, identifying charge correction, processing adjustments as needed and denial follow up according to payer rules and departmental policies.
Uses electronic billing system appropriately to follow up on outstanding denied claims and all no response claims.
Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if unable to resolve.
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, including reading newsletters and communicating payer/claim issues and trends.
Maintains 95% quality standards on account follow and activity.
Maintains productivity standard as set forth by management team.
Performs other duties as assigned.