Claims Processor II - Denials & Payer Follow-Up

MUSC Health; South Carolina; On-site; USD 25,000 - 39,000; Full time

Job summary

MUSC Health is seeking an experienced insurance claim processor to ensure accurate and timely processing of claims and denials. This role focuses on upholding payer rules, updating registrations, and following up on outstanding claims within a 40-hour week.

Candidates should have an Associate degree (preferred) and 2–4 years in hospital or physician-office billing, with knowledge of CPT coding and Epic. EEO employer; strong teamwork required.

Qualifications

• Associates Degree preferred with 2 years billing and insurance follow up or 4 years of billing and insurance follow up in a hospital or physician office setting.
• Thorough working knowledge of insurance terminology, CPT coding and billing rules.

Responsibilities

• Account maintenance: updating registration, authorization issues, charge corrections, processing adjustments and denial follow up per payer rules.
• Follow up on denied or no response claims by calling payers or using payer websites; gather information from patients to resolve.
• Use electronic billing system to correct missing/invalid information and place accounts on hold if unresolved.
• Escalate slow-pay issues to management and monitor payer trends to improve operations.
• Maintain 95% quality on account follow-up and overall productivity standards.
• Potential to cross-cover on teams and provide payer feedback in team meetings.
• Other duties as assigned.

Skills

Billing and insurance follow-up

Epic knowledge

CPT coding

Electronic billing system

Education

Associate degree preferred

Tools

Epic

Job description

MUSC Health is seeking an experienced insurance claim processor to ensure accurate and timely processing of claims and denials. This role focuses on upholding payer rules, updating registrations, and following up on outstanding claims within a 40-hour week.

Candidates should have an Associate degree (preferred) and 2–4 years in hospital or physician-office billing, with knowledge of CPT coding and Epic. EEO employer; strong teamwork required.