Claims Processor II

Medical University of South Carolina•Charleston, SC

About The Position

Under general supervision, the Claims Processor II is responsible for assuring accurate and timely insurance claim processing, including resolving claim edits and paper claims for submittal. The role also involves resolving denied or unpaid insurance claims in a timely manner. This is a regular, full-time employee position with scheduled weekly hours of 40, working in the SYS - HB Support Services cost center of the Medical University Hospital Authority (MUHA). The position requires independent judgment in handling patient accounts, with direct supervision available daily as conditions may require.

Requirements

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

Nice To Haves

Associate's Degree
Knowledge of Epic

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.
Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can't resolve.
Follow up on denied or no response claims by calling third party payers or using payer websites.
Gathering information from patients or other areas to resolve outstanding denied or no response claims.
Researching 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.
Uses payer websites to stay current on payer rules and changes to include 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.
Will serve as preceptor for Physician Patient Accounting and receive STAR certification.
Ability to cross-cover on any team as directed by management team or Director of Physician Patient Accounting.
Provide payer feedback during team meetings encourage collaboration among groups.
Collaborates with other claims processor II, to review and enhance existing workflows supporting training PPA team members.
Other duties as assigned.