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

Baptist Health System, Inc. • Akron, OH

2d • Hybrid

About The Position

Baptist Health is hiring a Claims Resolution Specialist III to join our Hospital Billing Office at Baptist Jacksonville (Downtown) in Jacksonville, FL. This is a full-time Hybrid opportunity, requiring 1-2 days on-site. The Hospital Billing Office plays a critical role in ensuring accurate and timely reimbursement for hospital services provided across Baptist Health. This role is ideal for an experienced revenue cycle professional with strong knowledge of claims processing, reimbursement, denial management, and accounts receivable who can independently resolve complex claims and identify trends that impact revenue cycle performance.

Requirements

• 3–5 years of experience working in an acute care setting
• 1–2 years Revenue Cycle Operations Experience
• Billing Experience
• Knowledge of CPT, ICD-10, HCPCS, and modifiers
• Medical Insurance Experience
• Reimbursement Experience
• Accounts Receivable Experience

Nice To Haves

• Bachelor of Arts/Bachelor of Science (BA/BS)
• Certified Revenue Cycle Specialist (CRCS)
• Certified Revenue Cycle Representative (CRCR)

Responsibilities

• Appropriately resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers
• Apply advanced revenue cycle knowledge across registration, eligibility, charge capture, clearinghouse, payment posting, claim denial, and credit management
• Analyze explanations of benefits (EOBs) to ensure proper payment to Baptist Health from responsible payers
• Communicate with third-party representatives as necessary to complete claims processing and resolve problem claims
• Perform daily follow-up on post-processing activities, including rejected billings, adjustments, corrected claims, overpayments, and denied claims
• Work assigned accounts according to established priorities based on account balance and age
• Identify trends in claim denials and communicate findings to leadership
• Collaborate with various departments to resolve outstanding claim issues and denial-related concerns
• Maintain current knowledge of CPT, ICD-10, HCPCS codes, and applicable modifiers

What This Job Offers

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