Medical 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

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 .