Revenue Cycle & Claims Resolution Specialist Job at AW Health Care (St Louis Metro Area)

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
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

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

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
Compliant with all CHRISTUS Health, payer, and government regulations
Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines

Fulltime

Medicaid Billing Specialist

Pafford Medical Services is seeking a detail-oriented and experienced Medicaid B...

Location

United States

Salary:

Not provided

Pafford EMS

Expiration Date

Until further notice

Requirements

Minimum of 2-3 years of experience in medical billing, with a focus on Medicaid billing and follow-up
In-depth knowledge of Medicaid regulations, coding (ICD-10, CPT), and billing procedures
Experience with medical billing software and electronic health records (EHR) systems
Strong analytical and problem-solving abilities
Excellent attention to detail and accuracy
Effective communication and interpersonal skills
Ability to work independently and manage multiple tasks
Proficiency in Microsoft Office Suite (Word, Excel)
High School Diploma or GED
Minimum of 2-3 years revenue cycle management experience

Job Responsibility

Accurately prepare and submit Medicaid claims for services rendered by Pafford EMS
Ensure all claims are coded correctly and comply with Medicaid regulations and guidelines
Monitor and verify patient eligibility and insurance coverage
Conduct follow-up on outstanding claims and ensure timely resolution of billing issues
Communicate with Medicaid offices, patients, and other relevant parties to resolve claim discrepancies, denials, or rejections
Review and appeal denied claims, providing necessary documentation and information
Maintain accurate and up-to-date records of billing activities, payments, and follow-ups
Generate regular reports on billing status, outstanding claims, and payment trends
Stay informed about changes in Medicaid regulations and billing procedures
Participate in training and development opportunities to enhance knowledge and skills

Fulltime

New

Claims Resolution Specialist I

Baptist Health is hiring a Claims Resolution Specialist I for our Hospital Billi...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

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
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

Fulltime

Medical Claims Specialist

We are looking for a dedicated Medical Claims Specialist to join our healthcare ...

Location

United States , Federal Way

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical collections, claims resolution, or revenue cycle management
Strong ability to interpret insurance contracts, documents, and regulatory guidelines
Knowledge of benefit verification and authorization processes within healthcare
Analytical skills to identify and address root causes of claim denials effectively
Reliable high-speed internet and familiarity with secure remote work systems
Proficiency in video conferencing and adherence to remote communication protocols
High level of responsiveness, urgency, and accountability in managing tasks
Ability to work exclusively for the organization without concurrent external roles

Job Responsibility

Conduct detailed benefit verification for patient insurance coverage to ensure accurate claims submission
Investigate and resolve unpaid or denied claims by analyzing root causes and utilizing available resources
Communicate effectively with insurance payers to address claim issues and facilitate timely payment
Interpret insurance contracts and regulations, ensuring compliance with state and employer-specific requirements
Participate in virtual meetings promptly, adhering to meticulous standards and security protocols
Utilize secure systems to manage sensitive data in a remote environment
Verify insurance authorizations and approvals accurately to support seamless claim processing
Collaborate with team members to resolve complex payment barriers and ensure smooth operations
Manage and resolve a set number of complex accounts daily, meeting productivity expectations
Respond promptly to supervisor and leadership inquiries during work hours, maintaining a high level of accountability

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Claims Resolution Specialist II

Baptist Health is hiring a Claims Resolution Specialist II for our Physician Bil...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

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

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

Fulltime

New

Revenue Cycle Specialist

We are looking for a skilled Revenue Cycle Specialist to join our team in Emeryv...

Location

United States , Emeryville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical coding with expertise in ICD-10 and CPT codes
Certification in medical coding (e.g., CPC, CCS, or equivalent) is required
Strong knowledge of outpatient coding and commercial insurance processes
Familiarity with handling claim denials and insurance appeals
Excellent analytical skills to identify and resolve coding discrepancies
Ability to work collaboratively with healthcare providers and insurance representatives
Attention to detail and commitment to maintaining accuracy in coding
Familiarity with current industry standards and regulations related to medical coding

Job Responsibility

Accurately apply ICD-10 and CPT codes to medical records and claims
Review and analyze outpatient coding to ensure compliance with regulatory standards
Manage and resolve insurance denials and claim discrepancies effectively
Collaborate with healthcare providers to validate coding accuracy and address coding-related inquiries
Monitor claims for commercial insurance to ensure timely processing and reimbursement
Identify trends in claim denials and implement corrective actions to minimize future issues
Assist in maintaining updated coding certifications and staying informed about changes in coding practices
Communicate with insurance companies to negotiate resolutions for denied claims
Support the revenue cycle team in optimizing workflows and achieving financial goals

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Revenue Cycle Specialist

We are looking for a skilled Revenue Cycle Specialist to join our team in Emeryv...

Location

United States , Emeryville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical coding with expertise in ICD-10 and CPT codes
Certification in medical coding (e.g., CPC, CCS, or equivalent) is required
Strong knowledge of outpatient coding and commercial insurance processes
Familiarity with handling claim denials and insurance appeals
Excellent analytical skills to identify and resolve coding discrepancies
Ability to work collaboratively with healthcare providers and insurance representatives
Attention to detail and commitment to maintaining accuracy in coding
Familiarity with current industry standards and regulations related to medical coding

Job Responsibility

Accurately apply ICD-10 and CPT codes to medical records and claims
Review and analyze outpatient coding to ensure compliance with regulatory standards
Manage and resolve insurance denials and claim discrepancies effectively
Collaborate with healthcare providers to validate coding accuracy and address coding-related inquiries
Monitor claims for commercial insurance to ensure timely processing and reimbursement
Identify trends in claim denials and implement corrective actions to minimize future issues
Assist in maintaining updated coding certifications and staying informed about changes in coding practices
Communicate with insurance companies to negotiate resolutions for denied claims
Support the revenue cycle team in optimizing workflows and achieving financial goals

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Revenue Cycle & Claims Resolution Specialist

AW Health Care

Location:
United States , St Louis Metro Area

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 19, 2026

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Location:United States , St Louis Metro Area

Category:-

Contract Type:Not provided

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Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:February 19, 2026

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Job Posted:
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