Claims Processor I

Medical University of South Carolina

1d•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.

Requirements

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

Responsibilities

Updating registration, authorization issues, identifying charge correction, 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 places 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 escalates slow-pay issues to managerial level when necessary.
Use payer websites to stay current on payer rules and changes, including reading newsletters and communicating payer/claim issues and trends.
Maintain 95% quality standards on account follow and activity.
Maintain productivity standard as set forth by management team.
Other duties as assigned.