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Denials and Appeals Specialist - Baptist Jacksonville

Date Posted: Apr 20, 2021

Status: Full-Time

Shift Details: Days

Job Summary

Baptist Health is hiring an experienced Denials and Appeals Specialist. This is a full-time position located in Downtown Jacksonville.

The Denials and Appeals Specialist will identify, research and route claim denials according to Baptist Health’s appeals workflow and in accordance with the appeal processes of the insurance company. The Denials and Appeals Specialist will perform initial claim denial root cause analysis, which may entail communicating with insurance companies and completing the necessary steps to resolve the problem.

Additional responsibilities include but are not limited to:

  • Resolving initial claim denial issues related to CPT codes, ICD 10 codes, NCCI edits, and MUE edits
  • Document all communications with patients and insurance companies in appropriate systems
  • Review patient balances to determine appropriate steps in the collections process
  • Communicate with collection agency on new and previous placed accounts
  • Review charity cases, probate cases, and bankruptcy cases
  • File and adjust claims accordingly

Education Required

High School Diploma/GED

Education Preferred

Associate's Degree

Experience

  • 3-5 Years Medical Coding Experience
  • 3-5 Years Medical Billing Experience
  • 1-2 years Customer Service Experience
  • 1-2 years Insurance Billing Experience
  • Knowledge base in ICD-10 and CPT4/HCPCS

License and Certification

  • Certified Hematology and Oncology Coder (CHONC)
  • Certfied Revenue Cycle Professional (CRCP)
  • Certfied Revenue Cycle Executive (CRCE)
  • Certified Procedural Coder (CPC)

Location

Baptist Jacksonville (Downtown)
800 Prudential Drive
Jacksonville, Florida, 32207


Location Overview

Baptist Health, founded in 1955, is North Florida’s most comprehensive healthcare system and the area’s only non-profit, mission-driven, locally governed healthcare provider. Our five nationally accredited hospitals, with 1,154 beds, include Baptist Medical Center Jacksonville; Wolfson Children’s Hospital; Baptist Medical Center Beaches; Baptist Medical Center Nassau and Baptist Medical Center South as well as Baptist Clay Medical Campus, which has a 24-hour freestanding Emergency Center. The most preferred healthcare system in the region, Baptist Health also includes 45 primary care offices, as well as home health, behavioral health, pastoral care, rehabilitation services, occupational health and urgent care.