Claims Resolution Specialist 1 - USFTGP TGMG RCO Back End
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Tampa General Hospital
Tampa, FL, US
Summary
The Claims Resolution Specialist is responsible for the accurate submission, follow-up, and resolution of third-party insurance claims to ensure correct reimbursement. They identify trends impacting claims, process appeals, and manage outstanding balances in accordance with regulatory requirements.
Job Description
The Claims Resolution Specialist I is responsible for the timely and accurate submission, follow‑up, and resolution of third‑party insurance claims to ensure correct reimbursement for services rendered. This position reviews assigned accounts, conducts status inquiries, processes appeals, and determines appropriate actions needed to resolve outstanding balances in accordance with departmental policies, payer guidelines, and regulatory requirements. The Specialist identifies trends impacting claims, assists with clean claim filing, and participates in special projects related to accounts receivable management. The role requires effective communication with payers, attention to detail, and adherence to State, Federal, and carrier regulations to support optimal financial performance for the organization.
Required:
High School Diploma or GED
Work Experience and Additional Information
2 years’ experience in physician billing and collection experience
• CPT ICD10 experience
• Experience with EPIC software
Technical Knowledge, Skills, and Abilities
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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.
Company size
10,001+ employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Tampa, FL
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.
Company size
10,001+ employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Tampa, FL
