Job Description Summary
Under general supervision assures accurate and timely insurance claim processing to include resolving claim edits and paper claims for submittal. Resolves denied/unpaid insurance claims in a timely manner.Entity
University Medical Associates (UMA) Only Employees and FinancialsWorker Type
EmployeeWorker Sub-Type
RegularCost Center
CC002058 UMA CORP RC PPA Physician Patient Accounting CCPay Rate Type
HourlyPay Grade
Health-20Scheduled Weekly Hours
40Work Shift
Job Description
- 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. Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can't resolve
- Follow up on denied or no response claims by calling third party payers or using payer websites. Gathering information from patients or other areas to resolve outstanding denied or no response claims. Researching accounts to take appropriate action necessary to resolve.
- Keep management aware of issues and trends to enhance operations and escalates slow-pay issues to managerial level when necessary.
- Uses payer websites to stay current on payer rules and changes to include reading newsletters and communicating payer/claim issues and trends.
- Maintains 95% quality standards on account follow and activity.
- Maintains productivity standard as set forth by management team.
- Other duties as assigned.
Additional Job Description
Education: High School Degree or Equivalent Work Experience: 0-6monthsIf 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.
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: http://www.uscis.gov/e-verify/employees
Skills Required
- High school diploma or equivalent
- 0-6 months relevant work experience
- Proficiency with electronic billing systems
- Knowledge of payer rules and use of payer websites
- Ability to research, follow up, and resolve denied/unpaid claims (including calling payers)
- Maintain departmental quality (95%) and productivity standards
What We Do
The Medical University of South Carolina (MUSC) is a public academic health system founded in 1824 and based in Charleston, South Carolina. MUSC combines patient care (MUSC Health), medical education, and biomedical research to advance health statewide and beyond. The institution trains health professionals, conducts translational research, and delivers comprehensive clinical services across South Carolina.
