Claims Resolution Specialist II, Physician Billing

Baptist Health

. Review and resolve medical claims submitted to commercial insurance companies, third-party organizations, and government payers .

Posted 9/22/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Revenue Cycle Operations, including knowledge of CPT, ICD-10, and HCPCS coding systems. Proficient in analyzing medical claims and collaborating with internal departments to resolve payment issues and denial trends.

Highest-signal resume keywords

Revenue Cycle Operations ExperienceMedical Insurance KnowledgeClaims ProcessingCPT, ICD-10, HCPCS KnowledgeAccounts Receivable Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewPayment PostingClaim Denial ManagementCharge CaptureEligibility VerificationClearinghouse OperationsDenial Trend AnalysisReimbursement AnalysisBilling AdjustmentsCorrected Claims Processing

Soft Skills

CommunicationCollaborationProblem-SolvingAttention to DetailAnalytical Thinking

Certifications & Qualifications

High School Diploma

Industry Keywords

Revenue CycleMedical ClaimsInsurance CompaniesThird-Party OrganizationsGovernment Payers

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

Full-time day shift opportunity
Remote work opportunity