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

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 III to join our Hospital Billing Office at Baptist Jacksonville (Downtown) in Jacksonville, FL. This is a full-time Hybrid opportunity, requiring1-2 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.

Claims Resolution Specialist III Job 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

Claims Resolution Specialist III Experience:

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

Claims Resolution Specialist III Education & Credential Requirements:

• High School Diploma (required)
• Bachelor of Arts/Bachelor of Science (BA/BS) (preferred)
• Certified Revenue Cycle Specialist (CRCS) (preferred)
• Certified Revenue Cycle Representative (CRCR) (preferred)

If you are interested in this full-time Claims Resolution Specialist III opportunity with the Hospital Billing Office at Baptist Jacksonville (Downtown), please apply today!

Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers
• The level III should have expertise in 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.

Primary Location: