Claims Processor II

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 Work Shift 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. 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: Thank you for wanting to be part of the Medical University of South Carolina team. Whether you want to teach the next generation of health care leaders, innovate new business models, discover the next breakthrough or provide patient care, there's a role for you that fuels your passion and takes advantage of your skills. There are career opportunities available in academics, research, hospital medicine, physician practices and support services, from patient billing to IT. As an applicant, you can search jobs for all MUSC entities as well as search by category and location. MUSC attracts more than $250 million annually in research funding, making it the biggest magnet for biomedical, extramural research dollars of all institutions of higher learning in South Carolina. The Clinical and Translational Science Award (CTSA) Program aims to advance clinical and translational science to increase the speed at which new treatments become available to patients. MUSC Health, the clinical enterprise, operates a 750 bed medical center, which includes a nationally recognized Children's Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of fewer than 70 elite National Cancer Institute designated centers), a Level I Trauma Center and the Institute of Psychiatry. In addition, there are more than 100 outreach clinics, hospital/health system affiliations, and telehealth sites. U.S. News & World Report placed us among the top one percent of all American hospitals, with 11 specialties in the top 50. The MUSC Medical Center is also one of only three Magnet designated hospitals in South Carolina. #J-18808-Ljbffr