Health Claims Specialist: AR & Denials Expert

Prisma Health; Greenville (SC); On-site; USD 42,000 - 62,000; Full time

Job summary

Prisma Health is seeking a Billing/Follow-Up professional to ensure accurate submission of claims to payer sources. You will focus on aging, high-dollar accounts, and follow up on variances while working with internal departments to resolve delays and denials.

The role requires knowledge of payer guidelines, HIPAA compliance, and strong communication to support accurate posting and timely payments across departments.

Qualifications

• High school diploma or equivalent minimum required, or a higher degree.
• Experience in hospital billing/follow-up or related claims work preferred.
• Familiarity with payer guidelines and claim edits is a plus.

Responsibilities

• Process billing functions and submit claims electronically or by paper.
• Follow up on specialty AR, review denials, and rebill when appropriate.
• Identify root causes of non-payment and coordinate with payers and Prisma Health.
• Escalate issues per guidelines and maintain compliance with HIPAA and standards.

Skills

Communication skills

Attention to detail

HIPAA compliance awareness

Education

High School diploma or equivalent

Bachelor’s degree (in lieu of experience)

Job description

Prisma Health is seeking a Billing/Follow-Up professional to ensure accurate submission of claims to payer sources. You will focus on aging, high-dollar accounts, and follow up on variances while working with internal departments to resolve delays and denials.

The role requires knowledge of payer guidelines, HIPAA compliance, and strong communication to support accurate posting and timely payments across departments.