Claims Recovery & Reimbursement Specialist

Nemours; Jacksonville (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, FL to resolve open insurance balances through collections and research unpaid, underpaid, and denied claims. The role requires applying contractual billing guidelines to ensure timely resolution and meet collection goals.

Essential functions include reviewing coding, billing and authorization terms, maintaining documentation, addressing customer inquiries, and accurately billing guarantors.

Qualifications

• High School Diploma required.
• 1-3 years of experience in medical billing or reimbursement.
• Experience with insurance denials and patient accounting.

Responsibilities

• Resolve open receivables by reviewing coding, billing, contracts and authorization terms.
• Research unpaid, underpaid and denied claims and apply guidelines to meet collection goals.
• Address inquiries on adjustments, account changes, guarantor merges, and transfers per enterprise guidelines.
• Handle insurance denials and underpayments, appealing/adjusting balances and billing the guarantor for patient responsibility.
• Enter patient demographics, guarantor and coverage data into Epic; adjust filing order and distribute payments correctly.

Skills

Collections

Insurance billing

Denials analysis

Customer service

Education

High School Diploma

Tools

Epic

Job description

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, FL to resolve open insurance balances through collections and research unpaid, underpaid, and denied claims. The role requires applying contractual billing guidelines to ensure timely resolution and meet collection goals.

Essential functions include reviewing coding, billing and authorization terms, maintaining documentation, addressing customer inquiries, and accurately billing guarantors.