Claims Processor I

Medical University of South Carolina•Orangeburg, SC

1d•Onsite

About The Position

Under general supervision, the Claims Processor I is responsible for the accurate and timely processing of insurance claims. This role involves resolving claim edits, submitting both paper and electronic claims, and ensuring that denied or unpaid claims are addressed and resolved promptly. The position is crucial for maintaining revenue integrity and supporting efficient revenue cycle operations within the Medical University Hospital Authority (MUHA).

Requirements

High school diploma or equivalent.
One (1) year of billing and insurance follow-up experience in a hospital or physician office setting.
General working knowledge of insurance terminology and billing rules.
Ability to prioritize daily workloads and exercise independent judgment when handling patient accounts.

Nice To Haves

Knowledge of Epic software preferred.

Responsibilities

Perform account maintenance activities, including updating registration and authorization information.
Identify and correct charge errors.
Process adjustments as needed.
Follow up on denials in accordance with payer rules and departmental policies.
Utilize the electronic billing system to follow up on outstanding denied claims.
Utilize the electronic billing system to follow up on claims with no payer response.
Correct claims for missing or invalid insurance or patient information per established procedures.
Place accounts on hold when issues cannot be immediately resolved.
Conduct follow-up on denied or no-response claims by contacting third-party payers by phone.
Conduct follow-up on denied or no-response claims by using payer websites and portals.
Gather necessary information from patients and internal departments to resolve outstanding claims.
Research accounts thoroughly to determine and take appropriate corrective actions.
Monitor and report issues or trends to management that may impact operations.
Escalate slow-pay issues when necessary.
Stay current on payer rules and changes by reviewing payer websites, newsletters, and communications.
Share relevant updates with the team.
Maintain a minimum 95% quality standard on account follow-up and activity.
Maintain productivity standards as established by management.
Perform other duties as assigned.