Claims Processor I

Job Description Summary

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.

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 Description:

• 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.

Education and Work Experience:

• 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.
• 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. 

Additional Job Description

Education: High School Degree or Equivalent Work Experience: 0-6months

Physical Requirements: Ability to perform job functions while standing. (Continuous) Ability to perform job functions while sitting. (Continuous) Ability to perform job functions while walking. (Continuous) Ability to climb stairs. (Infrequent) Ability to work indoors. (Continuous) Ability to work outside in temperature extremes. (Infrequent) Ability to work from elevated areas. (Frequent) Ability to work in confined/cramped spaces. (Frequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to bend at the waist. (Continuous) Ability to twist at the waist. (Frequent) Ability to squat and perform job functions. (Frequent) Ability to perform "pinching" operations. (Frequent) Ability to perform gross motor activities with fingers and hands. (Continuous) Ability to perform firm grasping with fingers and hands. (Continuous) Ability to perform fine manipulation with fingers and hands. (Continuous) Ability to reach overhead. (Frequent) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Continuous) Ability to fully use both legs. (Continuous) Ability to use lower extremities for balance and coordination. (Frequent) Ability to reach in all directions. (Continuous) Ability to lift and carry 50 lbs. unassisted. (Infrequent) Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. (Infrequent) Ability to lift from 36" to overhead 25 lbs. (Infrequent) Ability to exert up to 50 lbs. of force. (Frequent) Examples include: To transfer a 100 lb. patient that can not assist in the transfer requires 50 lbs. of force. For every 100 additional pounds, assistance will be required from another healthcare worker. 20 lbs. of force is needed to push a 400 lb. patient in a wheelchair on carpet. 25 lbs. of force is required to push a stretcher with a patient with one hand. Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous) Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Ability to deal effectively with stressful situations. (Continuous) Ability to work rotating shifts. (Frequent) Ability to work overtime as required. (Frequent) Ability to work in a latex safe environment. (Continuous) Ability to maintain tactile sensory functions. (Continuous) (Selected Positions) *Ability to maintain good olfactory sensory function. (Continuous) *(Selected Positions) *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)

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