Claims Resolution Specialist 1 - USFTGP UMSA RCO Back End

Tampa General Hospital; Tampa (FL); On-site; USD 40,000 - 60,000; Full time

Job summary

Tampa General Hospital is seeking a Claims Resolution Specialist I in Tampa, Florida. This role involves submitting, following up, and resolving third-party insurance claims to ensure accurate reimbursements. Candidates should have experience in billing and excellent communication skills.

The ideal applicant will possess a High School diploma and 2 years of relevant experience, including knowledge of EPIC software. A hybrid remote work option is available for this full-time position within a busy environment.

Qualifications

• 2 years’ experience in physician billing and collection.
• Understanding of third-party payer processes and claim workflows.
• Knowledge of State and Federal regulations related to claims.

Responsibilities

• Timely and accurate submission and follow-up of insurance claims.
• Identifying trends impacting claims and assisting with clean claim filing.
• Effective communication with payers to resolve outstanding balances.

Skills

Insurance claims resolution

Effective communication

Attention to detail

Problem-solving

Education

High School Diploma or GED

Tools

EPIC software

Job description

Job Description - Claims Resolution Specialist 1 - USFTGP UMSA RCO Back End (260002IM)

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

• High School Diploma or GED
• 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

Full-time

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