Claims Resolution Specialist , Hospital Billing Office Baptist Metro

About Baptist Health Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals.

Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.

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.

Claims Resolution Specialist I

Job 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, over payments, 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.

Claims Resolution Specialist I

Experience:

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)
Claims Resolution Specialist I Education & Credential Requirements:

High School Diploma (Required)
If you are interested in this full-time Claims Resolution Specialist I position at the Hospital Billing Office, 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, over payments, 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.

Primary

Location:

Metro Square