Claims Processor I Position Available In [Unknown county], South Carolina
Tallo's Job Summary: The Claims Processor I position in South Carolina, offered by the Hospital Authority (MUHA), involves accurately processing insurance claims, resolving claim edits, and submitting paper claims. Responsibilities include resolving denied/unpaid claims, updating registrations, and following up on outstanding claims according to payer rules. The role requires a High School Degree or Equivalent and 0-6 months of work experience.
Job Description
Claims Processor I
, South Carolina
Claims Processor I
R-0000045246
Remote
South Carolina
Patient Access, Records, Health Information, Medical Records & Coding
Business Operations
Full Time
Hospital Authority (MUHA)
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
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
