Medical Claims & Records Specialist

033 Palmetto GBA; Florence (SC); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

401(k) match

Subsidized health plans

Life insurance

Paid annual leave

Nine paid holidays

Job summary

Palmetto GBA is seeking a detail-oriented clerical professional to maintain records and process medical review claims. You will handle mail, prepare work for nursing staff, and troubleshoot claims before and after nurse review.

The role is computer-based with minimal phone contact, focusing on denials and claim adjustments, data integrity, and provider communications within a healthcare operations setting.

Qualifications

• Associate's Degree Equivalency or 2 years of related work experience.
• 1 year of administrative/clerical support experience is required.

Responsibilities

• Be the clerical backbone of Palmetto GBA's medical review team, ensuring nurses have complete, accurate information to make clinical decisions.
• This is computer-based work; phone contact is limited to returned-mail situations.
• Process denials of claims and adjust claims for pre-pay and post-pay departments.
• Investigate and analyze adjustment claim history and denial records.
• Prescreen records for review and maintain accurate records of all claims.
• Communicate with provider community and assist provider service department in inquiries.
• Generate educational correspondence to providers regarding denials.
• Perform quality control of work processes.
• Assist manager with special projects.

Skills

Word processing

Analytical

Organizational skills

Customer service

Verbal communication

Written communication

Spelling/Grammar

Discretion

Education

Associate's Degree Equivalency

Tools

Microsoft Office

Job description

Palmetto GBA is seeking a detail-oriented clerical professional to maintain records and process medical review claims. You will handle mail, prepare work for nursing staff, and troubleshoot claims before and after nurse review.

The role is computer-based with minimal phone contact, focusing on denials and claim adjustments, data integrity, and provider communications within a healthcare operations setting.