Claims Processor II - Denials & Payer Follow-Up Expert

Medical University of South Carolina; United States; Remote; USD 25,000 - 39,000; Full time

Job summary

Medical University of South Carolina is seeking an Insurance Claims Processor to ensure accurate and timely processing, resolve denials, and support revenue cycle operations. This role works under general supervision to follow payer rules and maintain high quality in account handling.

The position requires an associate degree or equivalent billing experience, knowledge of CPT codes, and familiarity with Epic.

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, identifying charge corrections, processing adjustments and denial follow up per payer rules.
• Use electronic billing system to follow up on outstanding denied claims and no response claims; corrects claims for missing info and places accounts on hold if unresolved.
• Follow up on denied or no response claims by contacting payers or using payer websites; gather patient information to resolve.
• Escalate issues and trends to management; stay current on payer rules and changes via payer portals and newsletters.
• Maintain 95% quality on account follow and activity; meet productivity standards set by the team.
• May serve as preceptor for Physician Patient Accounting and cross-cover on teams as directed.

Skills

Billing and follow-up

Insurance terminology

CPT coding knowledge

Payer rules compliance

Education

Associate degree

Billing experience

Tools

Epic

Job description

Medical University of South Carolina is seeking an Insurance Claims Processor to ensure accurate and timely processing, resolve denials, and support revenue cycle operations. This role works under general supervision to follow payer rules and maintain high quality in account handling.

The position requires an associate degree or equivalent billing experience, knowledge of CPT codes, and familiarity with Epic.