Claims Processor II

MUSC (Med. Univ of South Carolina) • Orangeburg, SC

69d

About The Position

Under general supervision assures accurate and timely insurance claim processing to include resolving claim edits and paper claims for submittal. Resolves denied/unpaid insurance claims in a timely manner.

Requirements

• High school diploma required.
• One year of billing and insurance follow up in a hospital or physician office setting preferred.
• General working knowledge of insurance terminology and billing rules.
• Knowledge of Epic preferred.

Nice To Haves

• 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.

Responsibilities

• Account maintenance: 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.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED