Claims Resolution Specialist I, Baptist Metro Square

Baptist Metro Square currently hiring for a Full-Time Claims Resolution Specialist I to join our team here in the Jacksonville.

As a Claims Resolution Specialist I, you will be responsible for:

• 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.

Experience Requirements:

• 1-2 years Customer Service Experience Required

• 1-2 years Healthcare experience required

• 1-2 years Insurance experience required

Education & Credential Requirements: 

• High School Diploma Required