Claims Processor II

MUSC Health; South Carolina; On-site; USD 25,000 - 39,000; Full time

Job summary

MUSC Health is seeking an experienced insurance claim processor to ensure accurate and timely processing of claims and denials. This role focuses on upholding payer rules, updating registrations, and following up on outstanding claims within a 40-hour week.

Candidates should have an Associate degree (preferred) and 2–4 years in hospital or physician-office billing, with knowledge of CPT coding and Epic. EEO employer; strong teamwork required.

Qualifications

• 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.
• Thorough working knowledge of insurance terminology, CPT coding and billing rules.

Responsibilities

• Account maintenance: updating registration, authorization issues, charge corrections, processing adjustments and denial follow up per payer rules.
• Follow up on denied or no response claims by calling payers or using payer websites; gather information from patients to resolve.
• Use electronic billing system to correct missing/invalid information and place accounts on hold if unresolved.
• Escalate slow-pay issues to management and monitor payer trends to improve operations.
• Maintain 95% quality on account follow-up and overall productivity standards.
• Potential to cross-cover on teams and provide payer feedback in team meetings.
• Other duties as assigned.

Skills

Billing and insurance follow-up

Epic knowledge

CPT coding

Electronic billing system

Education

Associate degree preferred

Tools

Epic

Job description

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

MUSC Community Physicians (MCP)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC004513 MCP - Revenue Cycle

Pay Rate Type

Hourly

Pay Grade

Health-22

Scheduled Weekly Hours

40

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.
• Will serve as preceptor for Physician Patient Accounting and receive STAR certification. Ability to cross-cover on any team as directed by management team or Director of Physician Patient Accounting. Provide payer feedback during team meetings encourage collaboration among groups. Collaborates with other claims processor II, to review and enhance existing workflows supporting training PPA team members.
• 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.

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