Claims Processor I

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.

The Claims Processor determine covered medical insurance benefits in accordance with the provisions of the plan document.

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

Additional Job Description

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

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. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.


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