Claims Processor I - Denials & Payer Follow-Up

Medical University of South Carolina; United States; Remote; USD 21,000 - 30,000; Full time

Job summary

Medical University of South Carolina is seeking a role focused on accurate and timely insurance claim processing and denial follow-up. Duties include updating registrations, resolving claim edits, and following payer rules to ensure claims are processed efficiently.

The position emphasizes following up on denied/no-response claims via payer portals or phone, maintaining high quality standards, and escalating issues as needed.

Qualifications

• High School Degree or Equivalent; 0-6 months work experience.

Responsibilities

• Account maintenance: Updating registration, authorization issues, identifying charge corrections, processing adjustments as needed and denial follow up according to payer rules and departmental policies.
• Use electronic billing system to follow up on outstanding denied claims and all no response claims; corrects claims for missing or invalid info; place account on hold if unresolved.
• Follow up on denied or no response claims by contacting third party payers or using payer websites; gather information from patients or other areas to resolve.
• Keep management aware of issues and trends to enhance operations and escalate slow-pay issues as needed.
• Uses payer websites to stay current on payer rules and changes; read newsletters and communicate payer/claim issues and trends.
• Maintains 95% quality standards on account follow and activity; maintains productivity as set by management.
• Other duties as assigned.

Education

High School Degree or Equivalent

Job description

Medical University of South Carolina is seeking a role focused on accurate and timely insurance claim processing and denial follow-up. Duties include updating registrations, resolving claim edits, and following payer rules to ensure claims are processed efficiently.

The position emphasizes following up on denied/no-response claims via payer portals or phone, maintaining high quality standards, and escalating issues as needed.