About this role
Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payers to ensure reimbursement. Reviews assigned accounts, determines appropriate action to resolve outstanding balances. Works within the established guidelines of the department’s procedures, policies and goals. Conduct studies/special projects to resolve outstanding accounts receivables.
Required:
• High School Diploma
Work Experience and Additional Information
• 2 years experience in physician billing and collection experience preferred
• CPT ICD9 experience
• IDX Software preferred
• Contact payers regarding outstanding claim status and determine appropriate action for swift resolution of outstanding claims
• Process appeals and claim resubmissions per payer policy and identify any trends that may allow for a front end edit to be put in
place to assist with clean claim filing
• As a Senior Claims Specialist, you will be expected to provide assistance to coworkers on the floor ensure all are supported in their daily functions
• Responsible for 2nd/3rd level appeals for any and all payers, making certain documentation being sent includes all necessary items
to support our claim
• Stay current on carrier guidelines, as well as State and Federal regulations
Other facts
About Tampa General Hospital
Tampa General is a private not-for-profit hospital and one of the most comprehensive medical facilities in West Central Florida serving a dozen counties with a population in excess of 4 million. As one of the largest hospitals in Florida, Tampa General is licensed for 982 beds, and with over 15,000 team members, is one of the region’s largest employers.
Consistently recognized for world-class care, Tampa General Hospital is ranked as the #1 hospital in Tampa Bay by U.S. News & World Report for 2024-25 and is nationally ranked as among the top 50 hospitals in the nation in eight specialties. Additionally, Tampa General was ranked as “high performing,” or among the top 10% of hospitals in the nation, in five more specialties along with 12 procedures and conditions.
TGH partners with the USF Health Morsani College of Medicine to pioneer breakthrough treatments, conduct game-changing clinical research and train the next generation of health care professionals. TGH is the region's only academic health system, having been affiliated with the USF Health Morsani College of Medicine since the school was created in the early 1970s.
TGH is the area’s only Level I trauma center and one of two ABA-verified Adult & Pediatric burn centers in Florida. With five medical helicopters, we are able to transport critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. The hospital is home to the leading organ transplant center in the country, having performed more than 14,000 adult solid organ transplants, including the state’s first successful heart transplant in 1985. Tampa General Hospital is committed to serving all residents of West Central Florida. We provide comprehensive health services, ranging from wellness and primary care to the most complex specialty care and post-acute services.
What you'll do
- The Claims Resolution Specialist 1 is responsible for the prompt and accurate submission and follow-up of all third-party claims. This includes reviewing assigned accounts, performing status inquiries, and conducting appeals to ensure reimbursement.
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