Claims Processor II Position Available In Orangeburg, South Carolina

Claims Processor II
Orangeburg, South Carolina
Claims Processor II
R-0000045319
Orangeburg, South Carolina
Patient Access, Records, Health Information, Medical Records & Coding
Business Operations
Full Time
Hospital Authority (MUHA)
Job Description Summary
In this role, you will be responsible for reviewing, analyzing, and processing insurance claims in accordance with policy provisions, regulatory guidelines, and organizational standards. The ideal candidate will have strong analytical skills, a solid understanding of claims procedures, and the ability to work efficiently in a fast-paced environment.
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-21
Scheduled Weekly Hours
40
Work Shift
Job Description
Job Purpose
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.
Licensures, Registrations, Certifications
N/A
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, possesses good finger dexterity, perform repetitive motions with hands/writs/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.
Job Duties
Claims Processor II
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
• 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.
• Associates Degree preferred with 2 years billing and insurance follow up or 4 years of billing and insurance follow up in a hospital or physician office setting required. Thorough working knowledge of insurance terminology, CPT coding and billing rules required. Knowledge of Epic preferred.