Claims Resolution Specialist I, Hospital Billing Office, Full-Time, Days, Baptist Jacksonville Metro
About The Position
Baptist Health is hiring a Claims Resolution Specialist I to join our Hospital Billing Office at the Baptist Metro Square in Jacksonville, FL. This is a full-time day shift opportunity. The Hospital Billing Office supports Baptist Health’s revenue cycle by ensuring medical claims are accurately processed and resolved to support timely reimbursement. The Claims Resolution Specialist I works with insurance companies, third-party organizations, and internal departments to resolve claim issues, investigate denials, and ensure appropriate payment. The ideal candidate will have foundational experience in revenue cycle operations, medical insurance, billing, or accounts receivable, along with strong attention to detail and problem-solving skills.
Requirements
- 1–2 years of Revenue Cycle Operations experience (Required)
- Less than 1 year of Accounts Receivable experience (Required)
- Less than 1 year of Billing experience (Required)
- Less than 1 year of Medical Insurance experience (Required)
- Less than 1 year of Reimbursement experience (Required)
- Less than 1 year of knowledge or experience with CPT, ICD-10, HCPCS, and modifiers (Required)
Responsibilities
- Review and resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers.
- Analyze explanations of benefits (EOBs) to verify appropriate payment to Baptist Health.
- Communicate with insurance carriers and third-party representatives to complete claims processing and resolve claim issues.
- Perform daily follow-up on rejected billings, adjustments, corrected claims, overpayments, and denied claims.
- Work assigned accounts according to 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, ICD-10, HCPCS, and modifiers while developing competency across assigned Hospital Billing (HB) or Physician Billing (PB) revenue cycle functions.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
