Enterprise Claims Resolution Specialist
2 weeks ago
The Enterprise Claims Resolution Specialist plays a crucial role in the assessment of technical denial claims and the submission of reconsiderations or appeals.
Reporting directly to the Enterprise Technical Denial Assistant Manager, this position is pivotal in enhancing the financial performance of the hospital's revenue cycle by ensuring a minimal denial rate and maximizing reimbursement rates at an enterprise level for UF Health Shands.
This role initiates a thorough root cause analysis of denied payments through various methods, including but not limited to: examining patient admissions and treatments, reviewing payer agreements, analyzing historical denial patterns, appeals, their outcomes, and identifying emerging trends in payer practices and requirements.
In collaboration with the Enterprise Technical Denial Assistance Manager and the Enterprise Senior Denial Manager, this role maintains a strong partnership with the Enterprise Managed Care Department to escalate and resolve unusual denial issues.
A comprehensive understanding of state and federal regulations pertaining to contracts and the appeals process is essential.
The Enterprise Claims Resolution Specialist is recognized as a technical denial authority in denial management, ensuring that all denied claims are meticulously addressed from a technical and billing standpoint.
Collaboration with various revenue cycle departments across the enterprise is key to establishing best practice solutions aimed at maximizing reimbursement and minimizing organizational write-offs.
QualificationsMinimum Education and Experience Requirements:
Education & Experience:
• High school diploma required, with four (4) years of experience in coding, billing, insurance follow-up, collections, or denial management within a hospital or clinical environment.
• An Associate’s degree or higher in a health or business-related field is preferred, along with three years of relevant experience in a hospital or clinical setting.
Knowledge, Skills, Abilities:
• Demonstrated knowledge of:
o Hospital billing and reimbursement processes
o Denials and appeals management
o Third-party payer contracts
o Federal and state regulations governing the healthcare sector
• Strong critical thinking and analytical capabilities
• Exceptional attention to detail with the ability to perform tasks with minimal errors and independently.
• Proficient organizational skills
• Excellent written and verbal communication skills
• Ability to prioritize tasks and manage time efficiently.
• Proficient in Microsoft Office Suite, including Outlook, Word, and Excel
• Familiarity with HIPAA guidelines
• Ability to read and interpret Explanation of Benefits (EOBs).
• Strong research and problem-solving abilities
Motor Vehicle Operator Designation:
Employees in this position:
Will not operate vehicles for business purposes.
Licensure/Certification/Registration:
None
-
Enterprise Claims Resolution Specialist
2 weeks ago
Gainesville, Florida, United States UF Health Shands Full timePosition OverviewThe Enterprise Claims Resolution Specialist plays a crucial role in evaluating technical denial claims and facilitating reconsiderations or appeals. Reporting directly to the Enterprise Technical Denial Assistant Manager, this position is dedicated to enhancing the financial performance of the hospital's revenue cycle by ensuring a minimal...
-
Medical Claims Specialist
1 week ago
Gainesville, Florida, United States Select Source International Full timeJob Overview**Job Title:** Medical Claims Specialist**Location:** Remote**Duration:** 6 Months**Job Type:** Full-time**About the Role:We are seeking a highly skilled Medical Claims Specialist to join our team at Select Source International. As a Medical Claims Specialist, you will be responsible for collecting patient accounts, filing claims, and reviewing...
-
Insurance Claims Specialist
2 weeks ago
Gainesville, Florida, United States Tower Hill Insurance Group LLC Full timePosition Overview:Tower Hill Insurance Group LLC is seeking two skilled Insurance Claims Specialists who thrive on intellectual challenges and are looking for a fulfilling career within a growing organization. As one of Florida's most reputable providers of homeowners insurance, Tower Hill Insurance is dedicated to offering exceptional opportunities for...
-
Claims Specialist
2 weeks ago
Gainesville, Florida, United States Tower Hill Insurance Group Full timePosition Overview:Tower Hill Insurance Group is seeking two skilled Claims Specialists to join our dynamic team. This opportunity is ideal for individuals who thrive on intellectual challenges and are looking for a fulfilling career within a growing organization. As a reputable name in homeowners insurance, Tower Hill Insurance provides excellent prospects...
-
Medical Claims Specialist
1 week ago
Gainesville, Florida, United States Select Source International Full timeJob OverviewAs a Medical Claims Specialist at Select Source International, you will play a critical role in the company's mission to provide exceptional services to clients and customers.Key Responsibilities:Collect and manage patient accounts, ensuring accurate and timely billing and payment processing.Review and analyze Explanation of Benefits (EOBs) from...
-
Insurance Claims Specialist
2 weeks ago
Gainesville, Florida, United States MedPro Group Full timeAbout MedPro GroupMedPro Group stands as a leading insurance provider under the Berkshire Hathaway umbrella, dedicated to serving our clients and supporting our team. Our diverse group of professionals unites with a common purpose: safeguarding those committed to serving and caring for others. Position OverviewThis role focuses on managing claims related to...
-
Claims Assessment Specialist
2 weeks ago
Gainesville, Florida, United States Tower Hill Insurance Group Full timePosition Overview:This opportunity is available for skilled Claims Representatives who thrive on intellectual challenges and are eager to advance their careers with a growing organization. Tower Hill Insurance Group is recognized as one of Florida's leading providers in homeowners insurance, offering substantial prospects for professional development and...
-
Warranty Claims Specialist
5 hours ago
Gainesville, Florida, United States Jenkins Kia of Gainesville Full timeJob SummaryThe Warranty Claims Specialist is responsible for the submissions, cancellations, and reconciliations of Warranty and Insurance products sold by Jenkins Kia of Gainesville. This role performs a combination of routine calculating, posting, and verifying duties to maintain accurate records.Key Responsibilities:Review files, records, and other...
-
Insurance Claims Specialist
2 weeks ago
Gainesville, Florida, United States MedPro Group Full timeAbout MedPro GroupMedPro Group stands as a leading insurance provider under the Berkshire Hathaway umbrella, dedicated to serving our clients and supporting our team. Our workforce comprises a diverse group of professionals, all united by a common mission: to safeguard those committed to serving and caring for others.Position OverviewThis role focuses on...
-
Gainesville, Florida, United States InsideHigherEd Full timeAbout the Position:We are seeking a highly skilled Researcher to join our team at InsideHigherEd in the cell adhesion laboratory of Professor Tina Izard. As a Researcher, you will play a key role in advancing our research in structural biology, with a focus on high-resolution structure determination and Unix knowledge.About the Laboratory:Our laboratory is a...
-
Insurance Accounts Receivable Specialist
3 days ago
Gainesville, Florida, United States The Cardiac & Vascular Institute Full timeJob SummaryThe Cardiac & Vascular Institute is seeking a highly skilled Insurance Accounts Receivable Representative to join our team. As a key member of our financial services department, you will be responsible for ensuring the accurate and timely processing of insurance claims, resolving denials and claim rejections, and maintaining a strong working...
-
Gainesville, Florida, United States UF Health Full timeJob SummaryWe are seeking a highly skilled Financial Analyst I Revenue Integrity Specialist to join our team at UF Health. The successful candidate will be responsible for facilitating financial, clinical, and decision support information in a team environment to support management objectives.Key ResponsibilitiesAnalyze and synthesize data from multiple...
-
Procurement Operations Specialist
2 weeks ago
Gainesville, Florida, United States University of Florida Full timeClassification Title:Procurement Support Specialist Job Description: This role is a vital component of the Procurement team, tasked with delivering continuous assistance to various University departments, vendors, and the broader community. Key responsibilities include:1. **Supplier Management:** Engaging with suppliers to ensure effective communication and...
-
Culinary Specialists
1 week ago
Gainesville, Florida, United States StaffWerk Full timeJob OverviewStaffWerk is a prestigious catering enterprise celebrated for its outstanding service and delectable cuisine. We are currently in search of talented and seasoned Culinary Specialists to enhance our operations. In this role, you will be instrumental in crafting exquisite dishes for various events and clients. Our dedication to delivering the...
-
Administrative Support Specialist
1 week ago
Gainesville, Florida, United States The Shigo Law Firm, P.A. Full timePosition OverviewRole Summary:The Administrative Support Specialist will serve as the initial point of contact for clients, managing communications through various channels including phone, email, and in-person interactions. All inquiries and relevant documents will be systematically recorded and directed to the appropriate personnel for resolution.Key...
-
Claims Processing Specialist
1 week ago
Gainesville, Florida, United States Jenkins Kia of Gainesville Full timePosition Overview The Warranty Administration Coordinator is tasked with managing the submissions, cancellations, and reconciliations of Warranty and Insurance products sold. This role involves a variety of routine calculations, postings, and verification duties to ensure precise record-keeping. The individual may also verify the accuracy of figures,...
-
Claims Processing Specialist
1 week ago
Gainesville, Florida, United States Jenkins Kia of Gainesville Full timeJob Overview The Warranty Administration Associate plays a crucial role in managing the submissions, cancellations, and reconciliations of Warranty and Insurance products sold. This position involves a variety of routine tasks including calculating, posting, and verifying records to ensure accuracy. The associate may also review the accuracy of figures and...
-
Clinical Coder III
1 week ago
Gainesville, Florida, United States InsideHigherEd Full timeJob DescriptionWe are seeking a highly skilled Clinical Coder III to join our team in the Department of Neurosurgery. As a key member of our revenue cycle team, you will be responsible for performing highly specialized diagnosis and procedural coding for all operative procedures and inpatient consulting services performed by the faculty of the Department of...
-
Residential Housekeeping Specialist
2 weeks ago
Gainesville, Florida, United States The Village Full timePosition Title:Housekeeping SpecialistOverview:The Housekeeping Specialist is tasked with the thorough cleaning and maintenance of resident living spaces and other designated areas within the facility. This role is vital in ensuring a clean and welcoming environment for our residents.Key responsibilities include performing a variety of cleaning duties such...
-
Sales Support Specialist
2 weeks ago
Gainesville, Florida, United States Offix LLC Full timePosition OverviewAs a Sales Support Specialist at Offix LLC, you will be essential in enhancing our customer relationships and driving sales initiatives. Your key responsibilities will include:1. Customer Engagement: Conduct regular outreach to our existing clientele to strengthen connections, evaluate their requirements, and provide assistance.2. Lead...