Medical Reimbursement Specialist

Nemours-Children; Jacksonville (FL); Remote; USD 45,000 - 65,000; Full time

Job summary

Nemours is seeking a Medical Reimbursement Specialist for a remote position based in Jacksonville, FL. You will resolve open insurance balances by researching unpaid, underpaid, and denied claims, applying contractual billing guidelines to ensure timely resolutions and meet collection goals.

The role requires 1–3 years of relevant experience and a High School Diploma, with responsibilities including denial management, accurate documentation in Epic, and collaboration with management to improve

Qualifications

• 1–3 years of relevant experience in medical billing or reimbursement.

Responsibilities

• Resolve open receivables by reviewing coding, billing, and contract terms.
• Investigate denials and underpayments; communicate with management on denial trends.
• Maintain accurate documentation of claim follow-up activities.
• Handle customer inquiries for adjustments, account changes, and transfers according to guidelines.
• Address insurance denials and underpayments; adjust balances as needed.
• Enter patient demographics, guarantor and coverage data into Epic system.
• Apply correct filing order; distribute payments to service dates; request changes when needed.
• Stay informed on insurance and system changes; provide excellent service aligned with Nemours' mission.

Education

High School Diploma

Tools

Epic

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