Claims Resolution Specialist I, Hospital Billing Office, Hybrid, Baptist Metro Square

Baptist Health System, Inc. • Akron, OH

1d • Hybrid

About The Position

Baptist Health is hiring a Claims Resolution Specialist I for our Hospital Billing Team department. This is a full-time days position located at Baptist Metro Square. The ideal candidate must have Claims Resolution experience working in a healthcare setting. Baptist Health is recognized as a top place to work in health care and is Northeast Florida's most preferred healthcare provider for over 30 years. As Jacksonville's only locally governed, faith-based, not-for-profit health system, Baptist Health offers a full spectrum of care through 200+ locations and six hospitals, including centers of excellence like Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute, and Wolfson Children's Hospital. Baptist Health's commitment to the community spans generations, focusing on innovative healthcare, improving health equity, and fostering a welcoming workplace where every team member's voice is heard.

Requirements

• Claims Resolution experience working in a healthcare setting
• Accounts Receivable Experience Required
• Billing Experience Required
• Knowledge of CPT, IOCD10, HCPCS, and Modifiers Required
• Medical Insurance Experience Required
• Reimbursement Experience Required
• 1 -2 years of Revenue Cycle Operations Experience Required
• High school diploma (or higher) Required

Responsibilities

• Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers.
• Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities.
• Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
• Follows-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.
• Requires 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED