Medical Reimbursement Specialist

Nemours in; Jacksonville (FL); On-site; USD 40,000 - 56,000; Full time

Job summary

Nemours Children's Health in Jacksonville, FL seeks a Medical Reimbursement Specialist to resolve open insurance balances by researching unpaid, underpaid, and denied claims. You will apply contractual billing guidelines and ensure timely resolution while maintaining thorough documentation and high-quality customer service.

The role emphasizes addressing denials, underpayments, and guarantor billing while accurately entering demographics in Epic and adhering to enterprise guidelines to support

Qualifications

• High school diploma required.
• 1–3 years of experience in medical billing or reimbursement.

Responsibilities

• Resolve open insurance balances by researching unpaid, underpaid, and denied claims.
• Apply contractual billing and payment guidelines to achieve timely resolution.
• Document claim follow-up activities accurately.
• Address inquiries for adjustments, changes, and transfers per guidelines.
• Enter patient demographics and coverage in the Epic system.
• Identify denial trends and report issues to management.

Skills

Customer service

Problem solving

Communication

Attention to detail

Education

High School Diploma

Tools

Epic

Job description

Medical Reimbursement Specialist (Finance)

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, FL

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.

Essential Functions

• 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.

Requirements

High School Diploma

1-3 years of experience

About Us

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida - along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.

Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.

Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.

Learn more at Nemours.org .