Claims Resolution Specialist I, Appeals and Denials, Baptist Metro Square

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 looking to add a Claims Resolution Specialist I to join our Appeals and Denials Team at Baptist Metro Square. This is a Full-Time Days opportunity.

Shift Details : Monday-Friday 8:00am - 5:00pm. Claims Resolution Specialist I, Appeals and Denials, Job Responsibilities: Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers. Have experience and demonstrated competency in at least 2 of the following areas within the revenue Cycle: Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, and Credit Management.

Analyzes 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. 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. Claims Resolution Specialist Experience: 1-2 years Revenue Cylce Operations Experience Required Less than 1 year Billing Experience Required Less than 1 year Medical Insurance Experience Required Less than 1 year Reimbursement Experience Required Less than 1 year Accounts Receivable Experience Required Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required If you are interested in this Claims Resolution Specialist I position at Baptist Metro Square, please apply now.

Primary Location: Metro Square