Summary
 

This position is part of our RCD (Review Choice Demonstration) Medicare Medical Review and Health Quality Team for Palmetto GBA. Position will be work from home after 4-6 months of onsite training in our Florence, SC office. To work from home, you must have high-speed non-satellite internet service and a private home office area.

Position Purpose:
Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes.

Description
 

Logistics:

Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

Location:

• First four to six months will be onsite. Once training is complete and performance standards are met, you may work from home. Position will be work from home after 4-6 months of onsite training in our Florence, SC office ( 160 Dozier Blvd, Florence, SC 29501). To work from home, you must have high-speed non-satellite internet service and a private home office area.
• This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need to work occasional overtime.

SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

What You’ll Do:

• Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments.
• Investigates and analyzes adjustment claim history and denial records.
• Prescreens records for review and maintains accurate records of all claims.
• Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials.
• Performs quality control of work processes.
• Assists manager with special projects.

To Qualify For This Position, You'll Need The Following:

• Required Work Experience: One year administrative/clerical support AND Claims processing experience.
• Required Education: Associate's Degree OR two years of related work experience.
• Required Skills and Abilities: Working knowledge of word processing software. Strong analytical, organizational, and customer se