Top 42 Claims representative Jobs in Lakeland Fl

AR Follow Up Denials Specialist - Denial & Appeals Mgmt
Lakeland Regional Health —Lakeland, FL
- $17.84 - $20.53 an hour
- Monday to Friday
- Hybrid work
- Background check
- Microsoft Excel
- Customer service
Quick Apply
2d
Customer Service Representative – Bilingual Spanish, Healthcare
Maximus —Brandon, FL
- $17.17 an hour
- Overtime
- HIPAA
- Office
- High school diploma or GED
- Paid training
- Paid holidays
8d
Patient Registration Rep
Central Florida Health Care, Inc. —Winter Haven, FL
- Spanish
- Computer literacy
- HIPAA
- Paid holidays
- Disability insurance
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Customer Service Representative - State Farm Agent Team Member
Mike Dluzniewski - State Farm Agent —Lakeland, FL
- $40,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- 401(k)
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Customer Service Representative - State Farm Agent Team Member
Bart Blessing - State Farm Agent —Lakeland, FL
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Dental insurance
Quick Apply
11d
Warranty Administrator
Asbury —Brandon, FL
- Full-time
- 18 years or older
- Dealership
- Pass drug screening
- Paid training
- Paid parental leave
Quick Apply
4d
Contact Center Representative
Systems Integration, Inc. —Tampa, FL
- Seasonal
- Remote
- Background check
- Computer literacy
- High school diploma or GED
- Paid training
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Customer Service Representative - State Farm Agent Team Member
Caz Piurowski - State Farm Agent —Lakeland, FL
- $45,000 - $70,000 a year
- Part-time
- Office
- Communication skills
- Entry level
- Opportunities for advancement
- Flexible schedule
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Customer Service Representative - State Farm Agent Team Member
Monica Maddox - State Farm Agent —Lakeland, FL
- $18.50 - $22.00 an hour
- Full-time
- Office
- Communication skills
- Entry level
- Opportunities for advancement
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Customer Service Representative - State Farm Agent Team Member
Jared Faniel - State Farm Agent —Lakeland, FL
- $15 - $18 an hour
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Automotive Warranty Administrator - Jarrett Gordon Ford Lincoln
Winter Haven —Winter Haven, FL
- $52,000 - $75,000 a year
- Microsoft Excel
- Microsoft Outlook
- Dealership
- Health insurance
- 401(k) matching
Quick Apply
Licensed Insurance Customer Service
Keith Hargrove - State Farm Agency —Lakeland, FL
- $50,000 - $75,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Healthcare Customer Service Representative (FL)
Healthcare Business Services Inc. —Tampa, FL
- On call
- Remote
- Computer literacy
- Writing skills
- Medical office experience
- Work from home
7d
Account Coordinator
WellDyne —Lakeland, FL
- Mid-level
- Office
- Bachelor's degree
Quick Apply
Construction Defect Major Case Specialist
The Travelers Companies, Inc. —Tampa, FL
- $104,000 - $171,700 a year
- Hybrid work
- 3 years
- High school diploma or GED
- Analysis skills
- Wellness program
- Paid holidays
Customer Service Representative - State Farm Agent Team Member
Courtney Paat - State Farm Agent —Plant City, FL
- $40,000 - $45,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- 401(k)
- Paid time off
Quick Apply
11d
Customer Service Representative - Healthcare
Maximus —Tampa, FL
- $15.61 an hour
- Overtime
- HIPAA
- English
- Office
7d
Customer Service Representative - State Farm Agent Team Member
Rachel Machin - State Farm Agent —Lakeland, FL
- $50,000 - $70,000 a year
- Full-time
- Spanish
- Office
- Communication skills
- Health insurance
- Paid time off
Quick Apply
Customer Relations Representative - State Farm Agent Team Member
Mike Dluzniewski - State Farm Agent —Lakeland, FL
- $60,000 - $90,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- 401(k)
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Karen Bryan - State Farm Agent —Winter Haven, FL
- $41,000 - $100,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
Quick Apply

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AR Follow Up Denials Specialist - Denial & Appeals Mgmt

Lakeland Regional Health -
Lakeland, FL

Quick Apply

Job Details

$17.84 - $20.53 an hour
2 days ago

Qualifications

Appeals
Customer communication
Microsoft Excel
HIPAA compliance
Medicare
Managed care
Customer service
Word embeddings
HIPAA
Workers' compensation insurance knowledge
High school diploma or GED
Medicaid health insurance
Math
Medicare regulations
Medical insurance appeals management
Medical explanation of benefits reviews
Medicaid regulations
Medicaid
Typing
Productivity software
Clinical confidentiality policies
Liability insurance
Insurance claims appeal handling
Quality data entry
Healthcare accounting

Full Job Description

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only designated Level 1 Trauma Center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 80.00
Shift : Monday - Friday 8:00 am to 4:30 pm

Location : Remote worker after training at 210 South Florida Avenue Lakeland, FL

Pay Rate : Min $17.84 Mid $20.53

Position Summary

Demonstrates commitment to the promises, vision, core purpose/mission and goals of LRMC, modeling the values and culture. Works under the supervision of the PFS Supervisor. The AR Follow and Denials Specialist is responsible for collecting payments for outstanding hospital claims, managing accounts, researching denials, submitting corrected claim requests, submitting appeals, and ensuring payments received are reconciled correctly with emphasis place on HIPAA compliance and in accordance with departmental goals, SOP’s, and contract terms. Responsible for adhering to all Federal regulations and maintaining current knowledge of all Insurance guidelines. Escalates payer denials trends or claims issues to the PFS Leadership Team to address with the payer. Identifies trends, system issues, and potential process improvements to avoid future delays and denials.

Position Responsibilities

Standard Work: AR Follow Up Denials Specialist

Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives
Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites.
Collect payments for outstanding claims and ensure payments received are reconciled correctly.
Confirm the claim expected reimbursement information to ensure claims are paid correctly. Follows department’s process for follow up on underpayments/overpayments.
Research and prepare responses for payor requests for additional information or documentation.
Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
Communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances.
Responsible for adequately working correspondence timely and efficiently (including EOBs, RA’s, denial letters).
Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
Identify complex and aged claims issues and follows internal escalation process appropriately.
Maintain patient confidentiality and privacy; adheres to HIPAA standards.
Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker.
Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

Competencies & Skills

Essential:

Four years general Patient Accounting experience including understanding of Managed Care contracts and claims analysis. Understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payers and their guidelines. Knowledge of healthcare rules and regulations.
An overall understanding of the appeals processes through completion.
Ability to read/interpret EOB’s
Working knowledge of Word, Excel or other Microsoft applications. Good analytical skills for problem solving, typing of 40 WPM and data entry.
Knowledge of Accounting Principles; analytical mathematical skills, professional customer service communication skills.
Demonstrates accuracy and thoroughness; Meets productivity standards; Completes work in timely manner.
Consistently shows ability to recognize and deal with priorities. Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events.
Knowledge of HIPAA guidelines.
Demonstrates good judgment and reasoning when investigating and solving problems. Good critical thinking skills.
Ability to prioritize and manage time effectively.

Nonessential:

Ability to prioritize and manage time effectively.

Qualifications & Experience

Essential:

High School or Equivalent

Nonessential:

Associate Degree

Nonessential:

Business or Healthcare Administration

Other information:
Experience Essential:

Two years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.

Experience Preferred:

Four years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.

Certifications Preferred:

AAHAM or HFMA certification

Work Location: Hybrid remote in Lakeland, FL 33801

Quick Apply

Refine Your Search

claims representative jobs in lakeland fl

AR Follow Up Denials Specialist - Denial & Appeals Mgmt

Customer Service Representative – Bilingual Spanish, Healthcare

Patient Registration Rep

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

Warranty Administrator

Contact Center Representative

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

Automotive Warranty Administrator - Jarrett Gordon Ford Lincoln

Licensed Insurance Customer Service

Healthcare Customer Service Representative (FL)

Account Coordinator

Construction Defect Major Case Specialist

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - Healthcare

Customer Service Representative - State Farm Agent Team Member

Customer Relations Representative - State Farm Agent Team Member

Multi-Line Representative - State Farm Agent Team Member

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Location : Remote worker after training at 210 South Florida Avenue Lakeland, FL

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