Scotland Health Claims Document Submission Specialist

## Scotland Health Claims Document Submission SpecialistApplylocations: Scotland Memorial Hospital - 500 Lauchwood Dr, Laurinburg, NC: Laurinburg, NC - 503 Lauchwood Drtime type: Full timeposted on: Posted Yesterdayjob requisition id: R244383**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 PreparationGather all necessary claim-related documents, including: Medical recordsPhysician notesOperative reportsReferral formsPrior authorizationsItemized billsUB-04 and CMS-1500 claim formsReview documentation for completeness, accuracy, and payer compliance before submission.**Claim Document Submission**Upload and submit required documentation through payer portals such as: AvailityNaviNetPayer-specific websites or electronic portalsEnsure correct association of documents with corresponding claims and patient accounts.Ensure timely submission to avoid timely filing denialsCommunicate with insurance rep as neededTroubleshoot claim issues related to documentation **Payer Request Management**Track documentation requests from insurance payers related to: Medical necessity reviewsPre-payment auditsClaim denialsAppeals and reconsiderationsMonitor 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 appealsKnowledge of payer-specific documentation requirementsPrior experience in hospital or physician billing environments**Knowledge, Skills, Abilities**Knowledge of healthcare revenue cycle processes and insurance claim workflowsFamiliarity with UB-04 and CMS-1500 claim formsExperience working with payer portals (e.g., Availity, NaviNet)Understanding of medical terminology and clinical documentationStrong attention to detail and organizational skillsAbility to manage multiple requests and deadlines simultaneouslyProficient in electronic medical record (EMR) systems**Key Performance Indicators (KPIs)**Timeliness of documentation submissionReduction in documentation-related denialsAccuracy and completeness of submitted recordsCompliance with payer requirements and audit standards #J-18808-Ljbffr