Medical Reimbursement Specialist

Nemours is seeking a Medical Reimbursement Specialist (Full-Time), 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.

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