Claims Processor II

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 II resolves denied/unpaid insurance claims in a timely manner. This position involves account maintenance such as updating registration, handling authorization issues, identifying charge corrections, processing adjustments, and denial follow-up according to payer rules and departmental policies. The role requires using an 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. It also involves following up on denied or no-response claims by contacting third-party payers or using payer websites, gathering information from patients or other areas, and researching accounts for appropriate action. The Claims Processor II is responsible for keeping management informed of issues and trends, escalating slow-pay issues, staying current on payer rules and changes, and maintaining quality and productivity standards. Additionally, this role may serve as a preceptor, receive STAR certification, cross-cover on other teams, provide payer feedback, and collaborate with colleagues to enhance workflows and support training. The position requires independent judgment in handling patient accounts, with direct supervision available daily. The Medical University of South Carolina is an Equal Opportunity Employer and participates in the federal E-Verify program.

Requirements

Associates Degree preferred with 2 years billing and insurance follow up or 4 years of billing and insurance follow up in a hospital or physician office setting required.
Thorough working knowledge of insurance terminology, CPT coding and billing rules required.
Able to prioritize work on a daily basis.
Requires independent judgement in handling patient accounts.

Nice To Haves

Knowledge of Epic preferred.

Responsibilities

Assures accurate and timely insurance claim processing.
Resolves 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, and denial follow up according to payer rules and departmental policies.
Uses electronic billing system 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.
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.
Maintains 95% quality standards on account follow and activity.
Maintains productivity standard as set forth by management team.
Serves as preceptor for Physician Patient Accounting and receive STAR certification.
Cross-covers on any team as directed by management team or Director of Physician Patient Accounting.
Provides payer feedback during team meetings.
Encourages collaboration among groups.
Collaborates with other claims processor II, to review and enhance existing workflows supporting training PPA team members.
Other duties as assigned.