Claims Resolution Specialist I, Appeals and Denials, Baptist Metro Square

Job Summary

Baptist Health is looking to add a Claims Resolution Specialist I to join our Appeals and Denials Team at Baptist Metro Square. This is a Full-Time Days opportunity.

Shift Details: Monday-Friday 8:00am - 5:00pm.

Claims Resolution Specialist I, Appeals and Denials, Job Responsibilities:

• Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers.
• Have experience and demonstrated competency in at least 2 of the following areas within the revenue Cycle: Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, and Credit Management.
• Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities. Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
• Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims.
• Works all assigned accounts on worklist in order depending on balance and age. Identify and communicate trends in denials to leadership.
• Communicates with various departments to resolve any outstanding issues with claim to resolve denials.
• Possesses up to date knowledge related to CPT codes, ICD/10 codes.

If you are interested in this Claims Resolution Specialist I position at Baptist Metro Square, please apply now.

Education Required

High School Diploma/GED

Education Preferred

Bachelor's Degree

Experience

• 1-2 years Revenue Cylce Operations Experience Required
• Less than 1 year Billing Experience Required
• Less than 1 year Medical Insurance Experience Required
• Less than 1 year Reimbursement Experience Required
• Less than 1 year Accounts Receivable Experience Required
• Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required

License and Certification

• Certified Revenue Cycle Specialist (CRCS) Preferred Or
• Certified Revenue Cycle Representative (CRCR) Preferred Or

Location

Location Overview

Baptist Health, founded in 1955, is North Florida’s most comprehensive health care system and the area’s only non-profit, mission-driven, locally governed health care provider. Baptist Health has over 200 points of care throughout the Northeast Florida region, including our six award-winning hospitals: Baptist Medical Center Jacksonville, Wolfson Children’s Hospital, Baptist Medical Center Beaches, Baptist Medical Center Clay, Baptist Medical Center Nassau and Baptist Medical Center South. The most preferred health care system in the region, Baptist Health also includes 57 primary care offices, as well as home health, behavioral health, pastoral care, rehabilitation services, occupational health and urgent care.