Medical Reimbursement Specialist

NemoursCareerSite; Jacksonville (FL); Remote; USD 42,000 - 64,000; Full time

Job summary

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, FL. The role focuses on resolving open insurance balances through collections and researching unpaid, underpaid, and denied claims to ensure timely resolution. This is a remote position with residency requirements in several states.

Applicants must reside in the listed states, including Florida. The essential duties include reviewing coding and contract terms, reporting denial trends, and accurately entering data into Epic

Qualifications

• High School Diploma required.
• 1–3 years of relevant healthcare billing experience.
• Experience with insurance claims, denials and adjustments.

Responsibilities

• Facilitate resolution of open receivables by review of coding, billing, contract terms, and authorizations.
• Diagnose and report issues with rejection and denial trends to management.
• Maintain accurate documentation of claim follow up activities.
• Address inquiries on adjustments, account changes, guarantor merges, and transfers per guidelines.
• Address insurance denials and underpayments, appealing / adjusting balances accordingly.
• Enter patient demographics, guarantor and coverage information into Epic.
• Change filing order, list necessary adjustments, distribute payments to service dates.

Skills

Medical collections

Insurance billing

Denial management

Customer service

Receivables follow-up

Education

High School Diploma

Tools

Epic

Billing systems

Job description

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.

This is a remote position.

Applicants must reside in one of the following states: Alabama, Colorado, Delaware, the District of Columbia, Florida, Georgia, Illinois, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

Essential Functions

1. Facilitate resolution of open receivables by review of coding, billing, contract agreements, and authorization terms
2. Diagnose and report issues with regards to rejection and denial trends to management
3. Maintain accurate documentation of claim follow up activities.
4. 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.
5. Address insurance denials and underpayments, appealing and/or adjusting balances as appropriate and accurately billing the guarantor for patient responsibility.
6. Accurately enter patient demographics, guarantor and coverage information into Epic system.
7. Accurately change filing order, ensure necessary adjustments are listed on account, distribute payments to correct service dates and request changes if needed.
8. 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 relevant experience