Department:
Scotland Memorial Hospital - Patient Financial ServicesStatus:
Full timeShift:
1st (United States of America)Schedule Details/Additional Information:
Job Description:
Duties and Responsibilities:
Document Retrieval and Preparation
Gather all necessary claim-related documents, including:
Medical records
Physician notes
Operative reports
Referral forms
Prior authorizations
Itemized bills
UB-04 and CMS-1500 claim forms
Review documentation for completeness, accuracy, and payer compliance before submission.
Claim Document Submission
Upload and submit required documentation through payer portals such as:
Availity
NaviNet
Payer-specific websites or electronic portals
Ensure correct association of documents with corresponding claims and patient accounts.
Ensure timely submission to avoid timely filing denials
Communicate with insurance rep as needed
Troubleshoot claim issues related to documentation
Payer Request Management
Track documentation requests from insurance payers related to:
Medical necessity reviews
Pre-payment audits
Claim denials
Appeals and reconsiderations
Monitor submission deadlines and ensure timely responses to avoid claim delays or denials.
Compliance and Accuracy
Verify that submissions comply with payer-provider guidelines, HIPAA regulations, and internal policies.
Maintain detailed records of all documents submitted, including submission dates and confirmation numbers.
Collaboration and Communication
Collaborate with coding, billing, utilization review, and clinical staff to obtain missing or clarifying documentation.
Communicate with payers as needed to resolve documentation issues or confirm receipt.
Position Qualifications
Education:
· High School graduate
· Associate’s degree in Healthcare Administration, Medical Office Technology, or a related field (preferred)
Experience:
Experience in claim follow-up, denials management, or appeals
Knowledge of payer-specific documentation requirements
Prior experience in hospital or physician billing environments
Knowledge, Skills, Abilities
Knowledge of healthcare revenue cycle processes and insurance claim workflows
Familiarity with UB-04 and CMS-1500 claim forms
Experience working with payer portals (e.g., Availity, NaviNet)
Understanding of medical terminology and clinical documentation
Strong attention to detail and organizational skills
Ability to manage multiple requests and deadlines simultaneously
Proficient in electronic medical record (EMR) systems
Key Performance Indicators (KPIs)
Timeliness of documentation submission
Reduction in documentation-related denials
Accuracy and completeness of submitted records
Compliance with payer requirements and audit standards
At Scotland Health Care System, we’re proud to employ a team of dedicated professionals who embody the Scotland Way.
Founded in 1946, Scotland Health Care System is a community-owned, not-for-profit organization serving Laurinburg, North Carolina. Our mission is simple yet powerful: to deliver safe, high-quality, compassionate, and sustainable health care to everyone in need.
We offer a full spectrum of services—including inpatient, outpatient, and emergency care—along with specialized programs in cancer treatment, cardiac care, surgical services, and women’s health.
Our culture is built on caring—for our patients and for our people. We believe that when we take exceptional care of our employees, they can provide exceptional care to our communities. That’s why we offer:
Competitive compensation
Family-friendly benefits including Paid Parental Leave and On-Site Childcare
Flexible scheduling
Exclusive savings programs
Career growth and advancement opportunities
If you’re looking for more than just a job—if you want a meaningful career where you can make a difference—Scotland Health Care System is the place for you. Join our team today!