Job Description Summary
Under general supervision, the Claims Processor assures accurate and timely insurance claim production and processing, including both resolving EDI claim edits and preparing paper claims for submittal/mailing. Resolve denied/unpaid insurance claims in a timely manner.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005226 SYS - HB Support Services
Pay Rate Type
Hourly
Pay Grade
Health-20
Scheduled Weekly Hours
40
Work Shift
Job Description
Job Summary/Purpose: Under general supervision, the Claims Processor assures accurate and timely insurance claim production and processing, including both resolving EDI claim edits and preparing paper claims for submittal/mailing. Resolve denied/unpaid insurance claims in a timely manner.
Required Minimum Training and Education: 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. Able to prioritize work on a daily basis. Requires independent judgement in handling patient accounts. Direct supervision available on a daily basis as conditions may require. Knowledge of Epic preferred.
Required Licensure, Certifications, Registrations: N/A
Additional Duties and Responsibilities:
- Account maintenance: Updating registration, authorization issues, identifying charge correction, debit or credit memos, 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 90% quality standards on account follow and activity.
- Maintains productivity standard as set forth by management team.
- Other duties as assigned.
Physical Requirements: Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently lift and/or carry objects weighing 20 lbs (+/-) unassisted. Lift from 36” to overhead 15 lbs. Infrequently work in dusty areas and confined/cramped spaces.
Additional Job Description
Required Minimum Training and Education: 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. Able to prioritize work on a daily basis. Requires independent judgement in handling patient accounts. Direct supervision available on a daily basis as conditions may require. Knowledge of Epic preferred.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
