Claims Processor II

Medical University of South Carolina•Orangeburg, SC

4d•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 also resolves denied/unpaid insurance claims in a timely manner. This position requires independent judgment in handling patient accounts, with direct supervision available as needed. The role involves account maintenance, updating registration, handling authorization issues, identifying charge corrections, processing adjustments, and denial follow-up according to payer rules and departmental policies. It also requires using an electronic billing system to follow up on outstanding denied and no-response claims, correcting claims with missing or invalid information, and gathering information from patients or other departments to resolve outstanding claims. The Claims Processor II will also research accounts for appropriate resolution, keep management informed of issues and trends, escalate slow-pay issues, and stay current on payer rules and changes by reading newsletters and communicating issues. Maintaining quality and productivity standards is essential.

Requirements

High school diploma required.
Able to prioritize work on a daily basis.
Requires independent judgment in handling patient accounts.
General working knowledge of insurance terminology and billing rules required.
Thorough working knowledge of insurance terminology, CPT coding and billing rules required.
Must maintain 95% quality standards on account follow and activity.
Must maintain productivity standard as set forth by management team.

Nice To Haves

One year of billing and insurance follow up in a hospital or physician office setting preferred.
Knowledge of Epic preferred.
Associates Degree preferred.
2 years billing and insurance follow up or 4 years of billing and insurance follow up in a hospital or physician office setting required.
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, including updating registration, authorization issues, identifying charge correction, and processing adjustments.
Follows up on denials according to payer rules and departmental policies.
Uses electronic billing system to follow up on outstanding denied and no-response claims.
Corrects claims in the electronic billing system for missing or invalid insurance or patient information.
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 the managerial level when necessary.
Uses payer websites to stay current on payer rules and changes.
Reads newsletters and communicates payer/claim issues and trends.
Maintains 95% quality standards on account follow and activity.
Maintains productivity standards as set forth by the management team.
Performs other duties as assigned.