Claims Processor I

Job Summary Job Description Summary MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina. Worker Information 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-21 Scheduled Weekly Hours 40 Work Shift Job Description Determine covered medical insurance benefits in accordance with the provisions of the plan document. Document medical claims processes by completing forms, reports, logs and records. Resolve medical claims by approving or denying, calculating benefit due and initiating payment or denial. Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations. Accurate and timely resolution of Epic PB and nThrive edits. Resolve rejections related to EDI based on carrier/departmental guidelines. Access applicable websites and VRU to verify effective/term date. Add indicated insurance to accounts/visits. Timely preparation of claims reviewing for accuracy for both primary and secondary, alerting management of any issues. Retrieval of required documentation from applicable system. If not retrievable, follow department guidelines for holding claim. Accurate notation of action taken in appropriate application per departmental guidelines. Minimum Education and Experience Education: High School Degree or Equivalent Work Experience: 0-6months Benefits Health, dental, vision, and life insurance Employer Sponsored Retirement Plan Paid time off and extended sick leave Paid Parental Leave Disability insurance plan options Continuous professional and clinical training Competitive pay Annual Merit Increase Wellbeing resources Tuition Reimbursement Employee perks and discounts Employee referral program Flexible schedule options Certification incentive program 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. E-Verify 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 C018 MUSC Community Physicians (MCP)