Claims Resolution Specialist 1 - USFTGP TGMG RCO Back End

Tampa General Hospital; Tampa (FL); On-site; USD 45,000 - 60,000; Part time

Job summary

Tampa General Hospital is seeking a Claims Resolution Specialist I to ensure timely submission, follow-up, and resolution of third-party insurance claims for accurate reimbursement. The role requires analyzing trends, handling appeals, and adhering to payer guidelines and regulations.

The position is part-time with hybrid remote eligibility in the Tampa area. Qualified candidates will have at least 2 years in physician billing, experience with EPIC, and strong communication skills to interact

Qualifications

• Minimum 2 years’ physician billing and collection experience.

Responsibilities

• Submit, follow-up, and resolve third-party insurance claims to ensure proper reimbursement.
• Review assigned accounts and respond to status inquiries; file appeals as needed.
• Identify trends affecting claims and support clean claim submissions to reduce denials.

Skills

Payer processes

Claim workflows

Denial analysis

Root cause analysis

Strong communication

Time management

Education

High School Diploma or GED

Tools

EPIC

Billing systems

Payer portals

Job description

Job Description - Claims Resolution Specialist 1 - USFTGP TGMG RCO Back End (260003F6)

Job Description

Description

The Claims Resolution Specialist I is responsible for the timely and accurate submission, follow‑up, and resolution of third‑party insurance claims to ensure correct reimbursement for services rendered. This position reviews assigned accounts, conducts status inquiries, processes appeals, and determines appropriate actions needed to resolve outstanding balances in accordance with departmental policies, payer guidelines, and regulatory requirements. The Specialist identifies trends impacting claims, assists with clean claim filing, and participates in special projects related to accounts receivable management. The role requires effective communication with payers, attention to detail, and adherence to State, Federal, and carrier regulations to support optimal financial performance for the organization.

Qualifications

Required:

High School Diploma or GED

Work Experience and Additional Information

2 years’ experience in physician billing and collection experience

• Experience with EPIC software

Technical Knowledge, Skills, and Abilities

• Understanding of third‑party payer processes, claim workflows, denial reasons, and reimbursement methodologies.
• Knowledge of State and Federal regulations, payer policies, appeal requirements, and compliance standards related to insurance claims.
• Ability to analyze claim issues, identify trends, determine root causes, and recommend solutions that support clean claim submission and reduce denials.
• Strong written and verbal communication skills for contacting payers, preparing appeals, and documenting claim activity accurately and professionally.
• Skills to manage a high‑volume workload, prioritize tasks, meet deadlines, and follow department protocols to ensure timely claim resolution.
• Ability to use billing systems, claim scrubbers, payer portals, and standard office software to review accounts, submit appeals, and track claim status.

Primary Location

Tampa

Work Locations

USF Faculty Office Building 13220 USF Laurel Dr Tampa 33612

Eligible for Remote Work : Hybrid Remote

Organization

Academic Medical Group Inc

Schedule

Part-time

Scheduled Days : Monday, Tuesday, Wednesday, Thursday, Friday