Claims Processor II

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

3d•Onsite

About The Position

The Claims Processor II role at MUSC Community Physicians (MCP) is responsible for updating account information, resolving authorization issues, processing charge corrections and adjustments, and following up on denied claims according to payer rules and departmental policies. This position requires the use of an electronic billing system to manage outstanding claims, correct information, and place accounts on hold when necessary. The role involves direct communication with third-party payers via phone and websites, gathering information from patients and other departments to resolve claim issues, and researching accounts for appropriate action. The Claims Processor II is expected to maintain high quality and productivity standards, keep management informed of trends, and escalate slow-pay issues. Additionally, this role may involve serving as a preceptor, cross-covering on different teams, providing payer feedback, and collaborating with colleagues to enhance workflows and train team members. The position requires independent judgment in handling patient accounts, with direct supervision available as needed.

Requirements

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

Nice To Haves

Associates Degree preferred.
Knowledge of Epic preferred.

Responsibilities

Update registration and authorization issues.
Identify and process charge corrections and adjustments.
Follow up on denied claims and no response claims according to payer rules and departmental policies.
Use electronic billing system to correct claims with missing or invalid information.
Place accounts on hold if claims cannot be resolved.
Contact third-party payers via phone or websites to resolve denied or no response claims.
Gather information from patients or other areas to resolve outstanding claims.
Research accounts to take appropriate action for resolution.
Keep management informed of issues and trends to enhance operations.
Escalate slow-pay issues to management when necessary.
Use payer websites to stay current on payer rules and changes.
Read newsletters and communicate payer/claim issues and trends.
Maintain 95% quality standards on account follow and activity.
Maintain productivity standards as set forth by the management team.
Serve as a preceptor for Physician Patient Accounting and receive STAR certification.
Cross-cover on any team as directed by management or the Director of Physician Patient Accounting.
Provide payer feedback during team meetings.
Encourage collaboration among groups.
Collaborate with other claims processor IIs to review and enhance existing workflows.
Support training of PPA team members.
Perform other duties as assigned.