Scotland Health Claims Document Submission Specialist

Department:
Scotland Memorial Hospital - Patient Financial Services

Status:
Full time

Shift:
1st (United States of America)

Schedule Details/Additional Information:

Job Description:

Duties and Responsibilities:

Document Retrieval and Preparation

Gather all necessary claim-related documents, including:


Medical records

Physician notes

Operative reports

Referral forms

Prior authorizations

Itemized bills

UB-04 and CMS-1500 claim forms

Review documentation for completeness, accuracy, and payer compliance before submission.

Claim Document Submission

Upload and submit required documentation through payer portals such as:


Availity

NaviNet

Payer-specific websites or electronic portals

Ensure correct association of documents with corresponding claims and patient accounts.

Ensure timely submission to avoid timely filing denials

Communicate with insurance rep as needed

Troubleshoot claim issues related to documentation


Payer Request Management

Track documentation requests from insurance payers related to:


Medical necessity reviews

Pre-payment audits

Claim denials

Appeals and reconsiderations

Monitor submission deadlines and ensure timely responses to avoid claim delays or denials.

Compliance and Accuracy

Verify that submissions comply with payer-provider guidelines, HIPAA regulations, and internal policies.

Maintain detailed records of all documents submitted, including submission dates and confirmation numbers.

Collaboration and Communication

Collaborate with coding, billing, utilization review, and clinical staff to obtain missing or clarifying documentation.

Communicate with payers as needed to resolve documentation issues or confirm receipt.

Position Qualifications

Education:


• High School graduate

• Associate's degree in Healthcare Administration, Medical Office Technology, or a related field (preferred)

Experience:

Experience in claim follow-up, denials management, or appeals

Knowledge of payer-specific documentation requirements

Prior experience in hospital or physician billing environments

Knowledge, Skills, Abilities

Knowledge of healthcare revenue cycle processes and insurance claim workflows

Familiarity with UB-04 and CMS-1500 claim forms

Experience working with payer portals (e.g., Availity, NaviNet)

Understanding of medical terminology and clinical documentation

Strong attention to detail and organizational skills

Ability to manage multiple requests and deadlines simultaneously

Proficient in electronic medical record (EMR) systems

Key Performance Indicators (KPIs)

Timeliness of documentation submission

Reduction in documentation-related denials

Accuracy and completeness of submitted records

Compliance with payer requirements and audit standards

Careers

At Scotland Health Care System, we're proud to employ a team of dedicated professionals who embody the Scotland Way.

Founded in 1946, Scotland Health Care System is a community-owned, not-for-profit organization serving Laurinburg, North Carolina. Our mission is simple yet powerful: to deliver safe, high-quality, compassionate, and sustainable health care to everyone in need.

We offer a full spectrum of services-including inpatient, outpatient, and emergency care-along with specialized programs in cancer treatment, cardiac care, surgical services, and women's health.

Our culture is built on caring-for our patients and for our people. We believe that when we take exceptional care of our employees, they can provide exceptional care to our communities. That's why we offer:

• Competitive compensation
  
• Family-friendly benefits including Paid Parental Leave and On-Site Childcare
  
• Flexible scheduling
  
• Exclusive savings programs
  
• Career growth and advancement opportunities
  

If you're looking for more than just a job-if you want a meaningful career where you can make a difference-Scotland Health Care System is the place for you. Join our team today!