Claims Resolution Specialist II, Physician Billing

🔥 17 hours ago

🏈 Alabama, Florida, +15 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🎸 Mississippi – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Baptist Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Baptist Health is the region’s largest not-for-profit healthcare organization based in South Florida. It operates a system of hospitals, outpatient centers, urgent care facilities and physician practices (including 12 hospitals, more than 29,000 employees, 4,500 physicians, and roughly 200 outpatient locations, per the provided information) and is organized around nationally recognized centers of excellence in cancer, heart and vascular, brain and spine, and orthopedic care. Baptist Health is faith-based, supported by philanthropy, and emphasizes clinical quality, patient safety, workforce development, and community-focused care; it also highlights workplace awards and high rankings in national hospital and specialty evaluations.

📋 Description

• 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 to complete claims processing and resolve outstanding issues • Collaborate with internal departments to resolve issues contributing to claim denials or payment delays • Identify and communicate denial trends and other revenue cycle concerns to leadership

🎯 Requirements

• 1–2 years of Revenue Cycle Operations 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 accounts receivable experience • Knowledge of CPT, ICD-10, HCPCS, and modifiers • Demonstrated competency in at least two revenue cycle areas, including Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, or Credit Management • High School Diploma • Must work in one of the following remote-approved states: Alabama, Florida, Georgia, Idaho, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia, or Wyoming

🏖️ Benefits

• Full-time day shift opportunity • Remote work opportunity