Medical Reimbursement Specialist

Nemours is seeking Reimbursement Specialist (Full-Time), to join our team in Jacksonville, Florida.

This position is responsible for effective follow up on accounts / invoices for assigned Payors resulting in payment or final adjustment. Proficiency in assigned Payors billing and payment guidelines is required, to ensure the departmental collection goals are met or exceeded as

• Work accounts / invoices until all charges are paid or denied by the insurance carrier.
• Process insurance / patient correspondence, deductibles, medical records request, non-covered services, adjustments and appeals.
• Process request for adjustments, account type changes, guarantor merges, and transfers when necessary, according to enterprise guidelines.
• Accurately enter patient demographics, guarantor and coverage information into Epic system.
• Accurately perform retro adjudication, change filing order, request necessary adjustments / reversal of adjustments, or refile claims.
• Distribute payments for assigned financial class to ensure payments are posted to correct service dates and request changes if needed.
• Identify and report payor trends and issues in order to effect timely resolution.
• Know and use data entry ground rules, Stand Business Practice, Nemours Intranet, Managed Care Manual and where to locate any hard copy or electronic versions.
• Keep abreast of all insurance and system changes, Payor Plan Standards, Just in Time Learning’s, News to Use, etc.
• Demonstrate excellent customer service that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours.

Performance Skills:

• Working knowledge in medical insurance billing guidelines required.
• Experienced in using reference materials: CPT, ICD9, HCPCS, CMS Guidelines, NCCI and Anesthesia reference materials.
• Demonstrate professional conduct with both internal and external customers.
• Ability to recognize and uphold confidentiality requirements expected by the Nemours Foundation.
• Works independently or as a team, takes direction, prioritizes, makes decisions, and accepts feedback with the willingness to accept change. 

Job Requirements

• High School Diploma required.
• Requesting knowledge of Physician Billing to include Medicaid specific billing payors - cpt coding knowledge. EPIC system billing knowledge.
• Must have billing knowledge of at least 2 years.     
• 1-3 years of job-related experience  

As one of the nation's premier pediatric health care systems, we've made a promise to do whatever it takes to prevent and treat even the most disabling childhood conditions. It's a promise that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention.

Equity, diversity, and inclusion guide our growth and strategy.  We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive environment.  All Nemours Associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.  

Nemours aspires to have its workforce and providers reflect the rich diversity of the communities we serve.  Candidates of diverse backgrounds, race and ethnicity, religion, age, gender, sexual orientation, and those committed to working with diverse populations and conversant in multicultural values are strongly encouraged to apply. Please click here to review Nemours Anti-Racism Statement (nemours.org). 

 

To learn more about Nemours and our commitment to treat every child as if they were our own, visit us at www.nemours.org.