Claims Editor

St. Joseph’s/Candler Health System; Savannah, Northern (GA, KY); Hybrid; USD 52,000 - 68,000; Full time

Job summary

St. Joseph’s/Candler Health System in Savannah, GA is seeking a Claims Editor to review, analyze, and resolve insurance claim edits and rejections to ensure compliance with federal and state regulations.

The role requires 2-3 years of healthcare claims experience, with a focus on billing efficiency and revenue cycle improvements. No license is required; a high school diploma is preferred, with opportunities to contribute across Patient Accounts and related departments.

Qualifications

• 2-3 years healthcare claims and reimbursement experience is required.
• High School Diploma preferred.
• License & Certification: None required.

Responsibilities

• Performs claims editing to ensure a positive cash flow. Screens and processes assigned claims edits and rejections accurately. Meets department time standards for corrections. Rebills claims when appropriate.
• Provides oversight of claims editing. Reviews and analyzes claims editing reports. Determines source of errors and rejections. Recommends process changes within Patient Accounts and other departments to ensure efficiency and compliance.
• Creates SSR inquiries to SSI for creation of edits to improve workflow.
• Works collaboratively to achieve efficiency and accuracy. Seeks answers/assistance when needed. Keeps up to date on billing/compliance rule changes.

Skills

Claims editing

Cash flow

Billing rules

SSI Meditech

Education

High School Diploma - Preferred

Tools

Meditech

SSI

Job description

• System - Specialty Physician Revenue Cycle

The Claims Editor is responsible to ensure all insurance claim edits and or rejections from Meditech and SSI are reviewed, analyzed and resolved. Ensure that the claims are compliant with federal and state regulations. Responsibilities include but are not limited to billing, prompt adding and follow-up of SSI tickets to enhance billing efficencies.Understands the laws that govern the billing.

Understands the laws that govern the billing.

Education

High School Diploma - Preferred

Experience

2-3 Years Healthcare claims and Reimbursement - Required

License & Certification

None Required

Core Job Functions

Performs claims editing to ensure a positive cash flow. Accurately screens and processes assigned claims edits and rejections. Meets departmental time standards for corrections. Rebills claims when appropriate.

Provides oversight of claims editing. Reviews and analyzes claims editing reports. Determines the source of errors and rejections. Recommends process changes within Patient Accounts and other departments to ensure efficiency and compliance.

Creates SSR inquiries to SSI for creation of edits for more efficient workflow.

Works collaboratively with others to achieve efficiency and accuracy. Seeks answers/assistance from the appropriate source. Keeps up to date on billing/compliance rule changes

Learn more about the many benefits available to SJ/C co-workers. From wellness programs and insurance options to child care and housing opporunities, SJ/C invests in the health and well-being of our co-workers in many ways.