Claims Resolution Specialist I, Appeals and Denials, Baptist Metro Square - Jacksonville
14 hours ago

Job description
Job Summary
Baptist Health is looking to add a Claims Resolution Specialist I to join our Appeals and Denials Team at Baptist Metro Square.
Shift Details:
Monday-Friday 8:00am - 5:00pm.
Claims Resolution Specialist I, Appeals And Denials, Job Responsibilities
Responsible for appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers.
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.
If you are interested in this Claims Resolution Specialist I position at Baptist Metro Square, please apply now.
Education Required
High School Diploma/GED
Preferred
Education Preferred
Bachelor's Degree
Experience
1-2 years Revenue Cylce Operations Experience Required
Less than 1 year Billing Experience Required
Less than 1 year Medical Insurance Experience Required
Less than 1 year Reimbursement Experience Required
Less than 1 year Accounts Receivable Experience Required
Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required
License and Certification
Certified Revenue Cycle Specialist (CRCS) Preferred Or
Certified Revenue Cycle Representative (CRCR) Preferred Or
Location
Metro Square
3563 Philips Highway
Jacksonville, FL, 32207
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