Medical Claims Processor

AppleOne • Columbia, SC

392d • $41,600 - $41,600

About The Position

The Medical Claims Processor position at AppleOne involves supporting the transition to a new Electronic Health Record (EHR) system within a dynamic healthcare environment. The role focuses on medical billing, claims processing, and payer credentialing, contributing to the optimization of the revenue cycle and improvement of healthcare delivery.

Requirements

• Credentialing experience is highly important.
• Strong knowledge of Medicare, Medicaid, and third-party payer billing processes.
• Experience with EHR systems, ideally Cerner-based platforms.
• Familiarity with computerized billing systems and management information systems (MIS).
• Ability to analyze claims and resolve discrepancies promptly.
• Flexibility to adjust to evolving program needs and requirements.

Responsibilities

• Maintain in-depth knowledge of program and payer policies, rules, and reimbursement regulations.
• Monitor revenue cycle claim queues and utilize Revenue Manager for claim submissions.
• Review claims for corrections, denials, and errors to ensure timely payments.
• Manage secondary claims for assigned payers post-primary claim adjudication.
• Handle payer enrollment processes statewide in the Electronic Health Record practice management system.
• Participate in presentations, workshops, and training sessions as needed.
• Adapt to changing program needs and provide support related to billing and revenue enhancement activities.

Benefits

• Health insurance
• Dental insurance
• 401(k)
• Vision insurance
• Paid sick time

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Administrative and Support Services
• Education Level: No Education Listed