Claims Processor II

Medical University of South Carolina•Orangeburg, SC

1d•Onsite

About The Position

Under general supervision, the Claims Processor II ensures accurate and timely insurance claim processing, including resolving complex claim edits and submitting paper and electronic claims. This role is responsible for proactively resolving denied and unpaid insurance claims while exercising independent judgment on patient accounts and contributing to overall revenue cycle performance.

Requirements

High school diploma or equivalent required
General working knowledge of insurance terminology and billing rules required
Demonstrated ability to prioritize daily workload and exercise independent judgment in handling patient accounts

Nice To Haves

One (1) year of billing and insurance follow-up experience in a hospital or physician office setting preferred
Knowledge of Epic preferred

Responsibilities

Perform comprehensive account maintenance activities, including: Updating registration and resolving authorization issues
Identifying and correcting charge errors
Processing claim adjustments as necessary
Conducting denial follow-up in compliance with payer rules and departmental policies
Utilize the electronic billing system to appropriately follow up on: All denied claims
Claims with no payer response
Correct claims for missing or invalid insurance or patient information according to established procedures; place accounts on hold when issues cannot be resolved independently
Research and resolve denied or no-response claims by: Contacting third-party payers via phone
Using payer websites and online portals
Gather necessary information from patients and internal departments to support claim resolution
Analyze claim data and account history to determine appropriate corrective actions
Proactively communicate trends, payer issues, and operational concerns to management; escalate slow-pay or problematic accounts as needed
Remain current on payer rules and changes by reviewing payer websites, newsletters, and communications and sharing relevant updates with leadership and team members
Maintain: A minimum of 95% quality standards for account follow-up and documentation
Productivity standards as established by the management team
Perform other duties as assigned