Claims Processor I-13 Position Available In Charleston, South Carolina

Claims Processor I-13
Charleston, South Carolina
Claims Processor I-13
R-0000046396
Charleston, South Carolina
Patient Access, Records, Health Information, Medical Records & Coding
Business Operations
Full Time
Hospital Authority (MUHA)
Job Description Summary
Determine covered medical insurance benefits in accordance with the provisions of the plan document. Document medical claims processes by completing forms, reports, logs and records. Resolve medical claims by approving or denying, calculating benefit due and initiating payment or denial. Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations.
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
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.
Additional Job Description

Education:

High School Degree or Equivalent Work Experience:

0-6months