MUSCP - Claims Processor I - Remote

  • R-0000003702
  • Remote
  • South Carolina
  • Charleston, South Carolina
  • Patient Access, Records, Health Information, Medical Records, and Coding
  • Business Operations
  • Full_time

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

University Medical Associates (UMA) Only Employees and Financials

Worker Type

Employee

Worker Sub-Type​

Regular

Department

CC002059 MUSCP | UMA CORP RC PPA Physician Patient Acct Admin CC

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

Work Shift

Job Description

Entity/Organization: MUSC Physicians (MUSCP)

Hours per week:  40

Scheduled Work Hours/Shift: Monday - Friday; 8:00am - 5:00pm

Pay Basis/FLSA:  Hourly/Non-Exempt

Remote Option: This position offers a remote work schedule

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

People like you also viewed

Registered Nurse II - Health - West Campus Ambulatory OR

R-0000002739 Charleston South Carolina United States Charleston Nursing Nursing & Advanced Practice Providers
Job Description Summary Under general supervision, the Registered Nurse II provides individualized, goal-directed patient care to families and patients at the competent level utilizing the principles and practices of the nursing process; delivers ...

MUSCP - HCC Administrative Director of Education and Training

R-0000005101 Charleston South Carolina United States Charleston Management-Business Operations Business Operations
Job Description Summary Entity University Medical Associates (UMA) Only Employees and Financials Worker Type Employee Worker Sub-Type​ Regular Department CC001331 MUSCP | HCC Administration CC Pay Rate Type Salary Pay Grade Health-35 Scheduled We...

Licensed Practical Nurse I

R-0000001651 North Charleston South Carolina United States North Charleston Healthcare Support Nursing & Advanced Practice Providers
Provides patient/family centered care, acting as partner and adviser, assists and supports patients and families to optimally manage their health care, respecting their culture and values, individual needs, health goals and treatment preferences. ...

CMA or LPN - North Charleston Children's Care (Sign On Bonus Available!)

R-0000001651 North Charleston South Carolina United States North Charleston Healthcare Support Nursing & Advanced Practice Providers
Job Description Summary The Certified Medical Assistant or LPN is responsible for quality patient care under the direction of a physician or licensed healthcare provider in a clinical practice. Duties to include rooming patients, taking vitals an...

UNIV_Dental Assistant IV_CDM, Digital Dentistry

R-0000005085 Charleston South Carolina United States Charleston Healthcare Support Clinical & Research Support Services
Job Description Summary Under general supervision, provides chair-side dental assistance and technical support to dental students, postgraduate dental residents, and faculty dentists. Provides clinical and administrative supporting the training of...

Therapeutic Assistant - Float Team

R-0000005105 Charleston South Carolina United States Charleston Human Services Clinical & Research Support Services
Job Description Summary The Therapeutic Assistant on the Psychiatric Nursing Central Pool Unit reports to the Nurse Manager. Under the direction of a registered nurse the Therapeutic Assistant is responsible for providing patient care as directed ...

Not ready to apply? Join our Talent Network to stay in the loop.

Not You?

Thank you for your interest in working at MUSC!

Get tailored job recommendations based on your interests.

Not You?

Thank you

Apply Now

Not You?

Thank you