Claims Resolution Specialist II, Physician Billing, Full-Time, Days, Baptist Jacksonville

About Baptist Health 
Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.

Baptist Health is hiring a Claims Resolution Specialist II to join our Physician Billing team in Jacksonville, FL. This is a full-time day shift opportunity.

The Physician Billing Office supports the revenue cycle by ensuring medical claims are accurately processed, payments are appropriately applied, and outstanding accounts are resolved efficiently. The Claims Resolution Specialist II plays an important role in resolving complex claims and identifying trends that may impact reimbursement. The ideal candidate will have revenue cycle experience and demonstrate competency in multiple areas of revenue cycle operations.

Claims Resolution Specialist II Job Responsibilities:

- Review and resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers.
- Analyze explanations of benefits to ensure accurate and appropriate payment to Baptist Health.
- Follow up on rejected billings, adjustments, corrected claims, overpayments, and denied claims.
- Work assigned accounts according to balance and age to support timely resolution and reimbursement.
- Communicate with insurance and third-party representatives as necessary to complete claims processing and resolve outstanding issues.
- Collaborate with internal departments to identify and resolve issues contributing to claim denials or payment delays.
- Identify and communicate denial trends and other revenue cycle concerns to leadership.

Claims Resolution Specialist II Experience:

- Required: 1–2 years of Revenue Cycle Operations 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: Less than 1 year of accounts receivable experience.
- Required: Knowledge of CPT, ICD-10, HCPCS, and modifiers.
- Preferred: Certified Revenue Cycle Specialist (CRCS).
- Preferred: Certified Revenue Cycle Representative (CRCR).
- Preferred: Demonstrated competency in at least two revenue cycle areas, including Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, or Credit Management.

Claims Resolution Specialist II Education & Credential Requirements:

- Required: High School Diploma
- Preferred: Bachelor of Arts/Science (BA/BS).

If you are interested in this full-time Claims Resolution Specialist II position with Baptist Health, please apply now!

This is a remote opportunity, candidate must work in the following remote approved states: AL, FL, GA, ID, IN, KY, LA, MS, NC, OH, OK, OR, SC, SD, TN, TX, VA, WV, WY

Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers. The level II specialist should have experience and demonstrated competency in at least 2 of the following areas within the revenue Cycle: Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, and Credit Management. Analyzes explanation of benefits to insure 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 but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims. Works all assigned accounts on worklist in order depending on balance and age. Identify and communicate trends in denials to leadership. Communicates with various departments to resolve any outstanding issues with claim to resolve denials. Possesses up to date knowledge related to CPT codes, ICD/10 codes.

Primary Location:

Remote - Florida