Medical Reimbursement Specialist

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

The primary function of the Medical Reimbursement Specialist is the resolution of open insurance balances through collections. The position is responsible for researching unpaid, underpaid and denied insurance claims then applying contractual billing and payment guidelines to ensure timely resolution and meet collection goals. 

• Facilitate resolution of open receivables by review of coding, billing, contract agreements, and authorization terms.
• Diagnose and report issues with regards to rejection and denial trends to management
• Maintain accurate documentation of claim follow up activities.
• Address inquiries on customer service encounters to include, but not limited to process requests for adjustments, account type changes, guarantor merges, and transfers when necessary, according to enterprise guidelines. 
• Address insurance denials and underpayments, appealing and/or adjusting balances as appropriate and accurately billing the guarantor for patient responsibility.
• Accurately enter patient demographics, guarantor, and coverage information into Epic system.
• Accurately change filing order, ensure necessary adjustments are listed on account, distribute payments to correct service dates and request changes if needed.
• Know and use standard business practices, keep abreast of all insurance and system changes, demonstrate excellent customer service that promotes patient, staff, and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours.
• Attend meetings regarding assigned Payors, team/department updates, etc.
• Assist insurance companies/guarantors with questions regarding charges and balances. 
• Work with other departments to resolve issues affecting reimbursement.
• Other duties as assigned.

Job Requirements

• High School Diploma required.  
• Minimum 1 year of experience required. 

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.