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Claims Processor I-9
Location
United States
Posted
3 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Claims Processor I-9
Medical University of South Carolina
Role 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. - 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. - Correct claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and place account on hold if unable to resolve. - Follow up on denied or no response claims by calling third party payers or using payer websites. - Gather information from patients or other areas to resolve outstanding denied or no response claims. - Research accounts to take appropriate action necessary to resolve. - Keep management aware of issues and trends to enhance operations and escalate slow-pay issues to managerial level when necessary. - Use payer websites to stay current on payer rules and changes to include reading newsletters and communicating payer/claim issues and trends. - Maintain 95% quality standards on account follow and activity. - Maintain productivity standard as set forth by management team. - Other duties as assigned. Qualifications - Education: High School Degree or Equivalent - Work Experience: 0-6 months 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
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