Job Description Summary
Under general supervision, the Claims Processor II ensures accurate and timely insurance claim processing, including resolving complex claim edits and submitting paper and electronic claims. This role is responsible for proactively resolving denied and unpaid insurance claims while exercising independent judgment on patient accounts and contributing to overall revenue cycle performance.Entity
Medical University Hospital Authority (MUHA)Worker Type
EmployeeWorker Sub-Type
RegularCost Center
CC005226 SYS - HB Support ServicesPay Rate Type
HourlyPay Grade
Health-21Scheduled Weekly Hours
40Work Shift
Job Description
Essential Duties and Responsibilities
Perform comprehensive account maintenance activities, including:
Updating registration and resolving authorization issues
Identifying and correcting charge errors
Processing claim adjustments as necessary
Conducting denial follow-up in compliance with payer rules and departmental policies
Utilize the electronic billing system to appropriately follow up on:
All denied claims
Claims with no payer response
Correct claims for missing or invalid insurance or patient information according to established procedures; place accounts on hold when issues cannot be resolved independently
Research and resolve denied or no-response claims by:
Contacting third-party payers via phone
Using payer websites and online portals
Gather necessary information from patients and internal departments to support claim resolution
Analyze claim data and account history to determine appropriate corrective actions
Proactively communicate trends, payer issues, and operational concerns to management; escalate slow-pay or problematic accounts as needed
Remain current on payer rules and changes by reviewing payer websites, newsletters, and communications and sharing relevant updates with leadership and team members
Maintain:
A minimum of 95% quality standards for account follow-up and documentation
Productivity standards as established by the management team
Perform other duties as assigned
Additional Job Description
Education: High school diploma or equivalent required
Work Experience: One (1) year of billing and insurance follow-up experience in a hospital or physician office setting preferred; General working knowledge of insurance terminology and billing rules required; Knowledge of Epic preferred; Demonstrated ability to prioritize daily workload and exercise independent judgment in handling patient accounts; Direct supervision available daily as operational needs require
Physical Requirements: Ability to perform job functions while standing. (Continuous) Ability to perform job functions while sitting. (Continuous) Ability to perform job functions while walking. (Continuous) Ability to climb stairs. (Infrequent) Ability to work indoors. (Continuous) Ability to work outside in temperature extremes. (Infrequent) Ability to work from elevated areas. (Frequent) Ability to work in confined/cramped spaces. (Frequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to bend at the waist. (Continuous) Ability to twist at the waist. (Frequent) Ability to squat and perform job functions. (Frequent) Ability to perform "pinching" operations. (Frequent) Ability to perform gross motor activities with fingers and hands. (Continuous) Ability to perform firm grasping with fingers and hands. (Continuous) Ability to perform fine manipulation with fingers and hands. (Continuous) Ability to reach overhead. (Frequent) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Continuous) Ability to fully use both legs. (Continuous) Ability to use lower extremities for balance and coordination. (Frequent) Ability to reach in all directions. (Continuous) Ability to lift and carry 50 lbs. unassisted. (Infrequent) Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. (Infrequent) Ability to lift from 36" to overhead 25 lbs. (Infrequent) Ability to exert up to 50 lbs. of force. (Frequent) Examples include: To transfer a 100 lb. patient that can not assist in the transfer requires 50 lbs. of force. For every 100 additional pounds, assistance will be required from another healthcare worker. 20 lbs. of force is needed to push a 400 lb. patient in a wheelchair on carpet. 25 lbs. of force is required to push a stretcher with a patient with one hand. Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous) Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Ability to deal effectively with stressful situations. (Continuous) Ability to work rotating shifts. (Frequent) Ability to work overtime as required. (Frequent) Ability to work in a latex safe environment. (Continuous) Ability to maintain tactile sensory functions. (Continuous) (Selected Positions) *Ability to maintain good olfactory sensory function. (Continuous) *(Selected Positions) *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)
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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