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Claims Resolution Specialist II

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Baptist Health (Florida)

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Location:
United States , Jacksonville

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Category:
Finance

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Contract Type:
Not provided

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Salary:

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Job Description:

Baptist Health is hiring a Claims Resolution Specialist II for our Physician Billing Team department. This is a full-time days position located at Baptist Metro Square. The ideal candidate must have Claims Resolution experience working in a healthcare setting.

Job Responsibility:

  • Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
  • Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
  • Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
  • Follows-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
  • Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
  • 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

Requirements:

  • High School Diploma/GED
  • 1-2 years Revenue Cycle 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

Nice to have:

  • Bachelor's Degree
  • Certified Revenue Cycle Specialist (CRCS) Preferred
  • Certified Revenue Cycle Representative (CRCR) Preferred

Additional Information:

Job Posted:
February 20, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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