Healthcare Claims Resolution Specialist

BHS; Akron (OH); Vor Ort; USD 50.000 - 75.000; Vollzeit

Zusammenfassung

Baptist Health in Jacksonville, FL is hiring a Claims Resolution Specialist I to join the Hospital Billing Office at the Metro Square location. This full-time day-shift role focuses on resolving claims with insurance payers, reviewing EOBs, and following up on denials to ensure timely reimbursement.

The ideal candidate has 1–2 years of revenue cycle experience and knowledge of CPT/ICD/HCPCS coding. Experience in HB or PB revenue cycle areas is a plus; HS diploma required.

Qualifikationen

• 1–2 years of Revenue Cycle Operations experience (Required)
• Less than 1 year of Accounts Receivable experience (Required)
• 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)
• Up-to-date knowledge of CPT, ICD-10, HCPCS, and modifiers (Required)

Aufgaben

• 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.
• Communicate with insurance carriers and third-party representatives to complete claims processing and resolve issues.
• Follow-up daily on post processing activity including rejected billings, adjustments, corrected claims, overpayments, and denied claims.
• Work assigned accounts on worklist by balance and age to support timely resolution.
• Identify trends in denials and communicate with leadership to resolve issues.

Kenntnisse

Revenue cycle operations

Accounts receivable

Billing

Medical insurance

Denials analysis

CPT/ICD coding

Ausbildung

High School Diploma

Tools

CPT

ICD-10

HCPCS

Coding modifiers

Jobbeschreibung

Baptist Health in Jacksonville, FL is hiring a Claims Resolution Specialist I to join the Hospital Billing Office at the Metro Square location. This full-time day-shift role focuses on resolving claims with insurance payers, reviewing EOBs, and following up on denials to ensure timely reimbursement.

The ideal candidate has 1–2 years of revenue cycle experience and knowledge of CPT/ICD/HCPCS coding. Experience in HB or PB revenue cycle areas is a plus; HS diploma required.