Claims Resolution Specialist I, Vendor Operations, Baptist Metro Square

Baptist Health - Jacksonville, FL

Full-time

Jacksonville, FL

Hospitals

About the position

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!

Responsibilities

• Resolve each medical claim sent to commercial insurance companies, third party organizations, and/or government payers.
• Analyze explanation of benefits to ensure 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 rejected billings, adjustments, corrected claims, overpayments, and denied claims.
• Work all assigned accounts on worklist in order depending on balance and age.
• Identify and communicate trends in denials to leadership.
• Communicate with various departments to resolve any outstanding issues with claims to resolve denials.
• Maintain up-to-date knowledge related to CPT codes, ICD/10 codes.

Requirements

• High school diploma or GED required.
• 1-2 years of experience in Revenue Cycle Operations preferred.
• 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 accounts receivable experience required.
• Knowledge of CPT, ICD-10, HCPCS, and modifiers required.

Nice-to-haves

• Bachelor's degree preferred.
• Certified Revenue Cycle Specialist (CRCS) preferred.
• Certified Revenue Cycle Representative (CRCR) preferred.