Baptist Health - Jacksonville, FL
posted 4 months ago
We are hiring a Claims Resolution Specialist I for Vendor Operations at Baptist Metro Square in Jacksonville, Florida. This is a full-time position that operates during the day, specifically from Monday to Friday, 8:00 AM to 5:00 PM. The Claims Resolution Specialist I will be an integral part of our small team, which is responsible for managing claims related to hospital vendors in collaboration with the Hospital Billing Team. The role is crucial in ensuring that claims are processed efficiently and accurately, thereby supporting the financial health of Baptist Health. In this position, the specialist will be tasked with resolving medical claims sent to various payers, including commercial insurance companies, third-party organizations, and government payers. The specialist will analyze explanations of benefits to ensure that Baptist Health receives proper payment from these entities. Effective communication with third-party representatives will be necessary to complete claims processing and resolve any problematic claims. Daily follow-up on post-processing activities is essential, which includes managing rejected billings, adjustments, corrected claims, overpayments, and denied claims. The Claims Resolution Specialist I will work through assigned accounts based on their balance and age, identifying and communicating trends in denials to leadership. This role requires a proactive approach to resolving outstanding issues related to claims, necessitating collaboration with various departments. A strong understanding of CPT codes, ICD-10 codes, and other relevant coding systems is essential for success in this position. If you are interested in joining our team as a Claims Resolution Specialist I at Baptist Metro Square, we encourage you to apply now!