Summary
 

Researches and resolves escalated, complex, and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include, but not limited to provider enrollment, medical review, appeals and/or finance. Completes research efficiently and accurately to ensure the departmental goals are achieved.

Description
 

Logistics:

This is a full-time position (40 HPW), and is located at our Columbia, SC location. This position will require that you work on-site, full-time.

What You Will Do:

• Researches and resolves high profile claims issues.

• Ensures claims processing errors are corrected according to the appropriate provider reimbursement contract.

• May also research and resolve high profile issues including, but not limited to provider enrollment, medical review, appeals and/or finance, which may be received via written or telephone correspondence.

• Serves as Point of Contact for various providers (professional and facility) to resolve all claims payment errors.

• Conducts weekly conference calls with assigned providers to ensure open communication pertaining to all current issues.

• Communicates/educates providers on proper coding of claims, claims filing, pricing concerns, contract questions, benefit/system updates, etc.

• Determines if claims payment errors are the result of system issues. Troubleshoots, and/or coordinates the resolution/correction of the system processing error.

To Qualify for This Position, You Will Need:

• Required Education: High School Diploma or equivalent.

• Required Work Experience: 5 years of combined claims and provider service experience in a healthcare environment OR 3 years of experience with claims systems (may be concurrent).

• Required Skills and Abilities:  Comprehensive knowledge of claims payment policies and refund policies.

• Working knowledge of related claims software systems.

• Knowledge of medical terminology and coding as appropriate.

• Strong analytical skills and the ability to retrieve and research automated reports.

• Strong time management skills and adaptable to change.

• Strong communication (verbal and written) communication skills.

• Required Software and Tools: Standard office equipment.

We Prefer That You Have:

• Preferred Education: Bachelor's degree-in Business, Computer Science, Healthcare Administration, or a related field.

• Preferred Skills and Abilities: Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis.

• Work Environment: Typical office environment.

What We Can Do for You:

• 401(k) retirement savings plan with company match.

• Subsidized health plans and free vision coverage.

• Life insurance.

• Paid annual leave – the longer you work here, the more you earn.

• Nine paid holidays.

• On-site cafeterias and fitness centers in major locations.

• Wellness programs and healthy lifestyle premium discount.

• Tuition assistance.

• Service recognition.

• Incentive Plan.

• Merit Plan.

• Continuing education funds for additional certificatio