Claims Resolution Specialist I: Denials & Reimbursements

135 Baptist Health System, Inc.; United States; On-site; USD 38,000 - 52,000; Full time

Job summary

135 Baptist Health System, Inc. in Jacksonville, FL seeks a Claims Resolution Specialist I to join our Hospital Billing Office at Metro Square.

This full-time day-shift role supports revenue cycle by reviewing and resolving medical claims, analyzing explanations of benefits, and ensuring correct payments from payers. The ideal candidate has foundational revenue cycle experience, including insurance, billing or accounts receivable, with strong attention to detail and problem-solving skills.

Qualifications

• 1–2 years of Revenue Cycle Operations experience.
• Less than 1 year of Accounts Receivable experience.
• Less than 1 year of Billing experience.
• Less than 1 year of Medical Insurance experience.
• Less than 1 year of Reimbursement experience.
• Less than 1 year of knowledge or experience with CPT, ICD-10, HCPCS, and modifiers.

Responsibilities

• Review and resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers.
• Analyze explanations of benefits (EOBs) to verify appropriate payment to Baptist Health.
• Communicate with insurance carriers and third-party representatives to complete claims processing and resolve claim issues.
• Perform daily follow-up on rejected billings, adjustments, corrected claims, overpayments, and denied claims.
• Work assigned accounts according to balance and account age to support timely resolution and reimbursement.
• Identify and communicate denial trends to leadership and collaborate with internal departments to resolve outstanding claim issues.
• Maintain knowledge of CPT, ICD-10, HCPCS, and modifiers while developing competency across assigned Hospital Billing (HB) or Physician Billing (PB) revenue cycle functions.

Skills

Revenue Cycle Operations

Accounts Receivable

Billing

Medical Insurance

Problem Solving

Education

High School Diploma

Job description

135 Baptist Health System, Inc. in Jacksonville, FL seeks a Claims Resolution Specialist I to join our Hospital Billing Office at Metro Square.

This full-time day-shift role supports revenue cycle by reviewing and resolving medical claims, analyzing explanations of benefits, and ensuring correct payments from payers. The ideal candidate has foundational revenue cycle experience, including insurance, billing or accounts receivable, with strong attention to detail and problem-solving skills.