Claims Resolution Specialist I, Hospital Billing Office, Full-Time, Days, Baptist Jacksonville

Job Summary

Baptist Health is hiring a Claims Resolution Specialist to join our Revenue Cycle team in Jacksonville, FL. This is a full-time day shift opportunity.

The Revenue Cycle team supports the financial health of Baptist Health by ensuring medical claims are accurately processed, followed up on, and resolved. The Claims Resolution Specialist works with insurance companies, third-party organizations, and internal departments to resolve claim issues and support timely reimbursement. The ideal candidate will have revenue cycle experience and knowledge of medical billing, insurance, reimbursement, and coding.

Claims Resolution Specialist Job Responsibilities:

• Resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers.
• Analyze explanations of benefits (EOBs) to ensure accurate payment to Baptist Health.
• Communicate with third-party representatives as needed to complete claims processing and resolve problem claims.
• Perform daily follow-up on rejected billings, adjustments, corrected claims, overpayments, and denied claims.
• Work assigned accounts based on balance and account age to support timely resolution and reimbursement.
• Identify and communicate denial trends to leadership and collaborate with internal departments to resolve outstanding claim issues.
• Maintain knowledge of CPT and ICD-10 codes and work toward competency across assigned revenue cycle areas, including Hospital Billing (HB) and Physician Billing (PB).

Claims Resolution Specialist Experience:

• Experience in Accounts Receivable.
• Experience in medical billing.
• Experience with medical insurance.
• Experience with reimbursement.
• Experience in Revenue Cycle Operations.
• Knowledge of CPT, ICD-10, HCPCS, and modifiers.
• Experience in either Hospital Billing (HB) or Physician Billing (PB), with the ability to develop competency across assigned revenue cycle areas.

Claims Resolution Specialist Education & Credential Requirements:

• High School Diploma (Required)

If you are interested in this full-time Claims Resolution Specialist position with Baptist Health, please apply now!

Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers• Anaylzes 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• Experience in either HB or PB while working toward competency in all areas of the assigned vertical• 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.

Education Required

High School

Experience

• Billing Experience
• Accounts Receivable Experience
• Revenue Cylce Operations Experience
• Reimbursement Experience
• Medical Insurance Experience
• Knowledge of CPT, ICD10, HCPCS and Modifiers

License and Certification

• Driver's License - DMV

Location