Claims Resolution Specialist I, Hospital Billing Office Job at Baptist Health (Florida) (Jacksonville)

Billing Specialist, Revenue Cycle, FT

Responsible for working/editing daily download of assigned Managed Care/HOM clai...

Location

United States , Boca Raton

Salary:

16.04 - 19.41 USD / Hour

Baptist Health

Expiration Date

Until further notice

Requirements

Degrees: High School,Cert,GED,Trn,Exper.
AA preferred or equivalent
Managed Care/HMO contract billing experience required
3-5 years prior experience in Billing of claims
Understanding of all required fields on a 1500 and/or UB for hospitals and diagnostic facilities is required
Background in coding or coding certification (CPC, CPC-H, CCS, or RMC) a plus
Exp in other related Business Office Functions including Federal Programs, such as: Collections, refunds, review and adjudication of claims a plus
Knowledge and understanding of: Medical terminology, Correct Coding Initiative, Revenue Codes, DRG Guidelines, ICD-9/10, CPT-4, Modifiers & HCPCS codes, HIPAA regulations, statutory regulations, On-line verifications (DDE)
Internet savvy
knowledge of Microsoft Suite a must

Job Responsibility

Working/editing daily download of assigned Managed Care/HOM claims
Optimizing the timely transmittal of accurate and clean claims daily
Identifying and obtaining invalid/missing claim data by communicating with other depts. to secure and/or correct the data which prevents claim transmission
Protecting payer filing deadlines by utilizing all available resources to resolve held claims
Assuring all known regulatory, contractual, compliance, and BHSF guidelines are adhered to
Taking on additional queues as back up to billing all carriers
Utilizing available system resources to resolve claim issues when appropriate
Reporting any billing system issues to Billing management
Assisting other Billing Specialists with claim resolution or other projects as assigned

What we offer

Career growth and development opportunities
Comprehensive health and wellness resources
Wellness program that can help employees eliminate their medical plan deductible
Tuition reimbursement

Fulltime

Claims Resolution representative iv

Wilmot Cancer Institute is looking for an experienced, compassionate, and detail...

Location

United States of America , Brockport

Salary:

20.99 - 28.34 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree in Business Administration and 2 years of hospital patient accounting or consumer collections experience
or an equivalent combination of education and experience
Ability to type 25 wpm
Experience working with transplant programs including, but not limited to transplant contracting, transplant provider relations, transplant billing and collections, etc.
Must be able to multi-task and pivot across duties as needed

Job Responsibility

Acts as billing and collections resource
Completing National Marrow Donor Billing
Responsible for resolving Work Queues in EPIC
Research and analyze denials
Routinely works hospital reports to ensure claims are sent timely
Edits follow up bills originated by EPIC
Responsible for communicating with insurance companies, other payers, and patients
Trains all claims resolution specialists that join the WCI Business office

Fulltime

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications
All applicants applying for U.S. job openings must be legally authorized to work in the United States

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

Patient Financial Specialist - Patient Financial Services

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
1-3 years of experience preferred
Experience working within a multi-facility hospital business office environment preferred
College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience
Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
Knowledge in locating and referencing CMS and/or Medicare Regulations preferred.

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics
Ensures PFS departmental quality and productivity standards are met
Collects and provides patient and payor information to facilitate account resolution
Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission
Responds to all types of account inquires through written, verbal, or electronic correspondence
Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution
Meets or exceeds customer expectations and requirements
Compliant with all CHRISTUS Health, payer, and government regulations

Fulltime

Patient Financial Specialist

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
1-3 years of experience preferred
Experience working within a multi-facility hospital business office environment preferred
College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience
Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
Knowledge in locating and referencing CMS and/or Medicare Regulations preferred

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics
Ensures PFS departmental quality and productivity standards are met
Collects and provides patient and payor information to facilitate account resolution
Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission
Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission
Responds to all types of account inquires through written, verbal, or electronic correspondence
Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers
Maintains working knowledge of all functions within the Revenue Cycle
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution

Fulltime

Patient Financial Specialist Lead

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalency required
5-7 years of experience preferred
Demonstrated success working in a team environment focused on meeting organization goals and objectives required
Must have an understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred
Experience working within a multi-facility hospital business office environment preferred

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network
Provide on-the-job training as needed and provide a source of knowledge for staff inquiries
Demonstrates a strong understanding of payer benefits requirements, on-line claims status, submission, billing, cash application, and reconciliation procedures
Approve or deny requested adjustments and refunds within role thresholds
Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned
Remain flexible if duties are reassigned, which may involve transferring to a more appropriate unit in order to best serve PFS and CHRISTUS Health
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution while maintaining account integrity and compliance with payer and/or government regulations
Ensures quality and productivity standards are met or exceeded
Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures

Fulltime

Patient Financial Specialist - Patient Financial Services

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
Post HS education preferred
1-3 years of experience preferred
Experience working within a multi-facility hospital business office environment preferred
College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience
Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
Knowledge in locating and referencing CMS and/or Medicare Regulations preferred
None required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics
Ensures PFS departmental quality and productivity standards are met
Collects and provides patient and payor information to facilitate account resolution
Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission
Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission
Responds to all types of account inquires through written, verbal, or electronic correspondence
Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers
Maintains working knowledge of all functions within the Revenue Cycle
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution

Fulltime

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Claims Resolution Specialist I, Hospital Billing Office

Job Description

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