Remote Medical Reimbursement Specialist - Insurance Claims

Nemours Children's Health; Jacksonville (FL); À distance; USD 52 000 - 76 000; Plein temps

Résumé du poste

Nemours Children's Health in Jacksonville, FL is seeking a Medical Reimbursement Specialist to resolve open insurance balances through diligent claim follow-up and coding/billing review. You will research unpaid, underpaid, and denied claims, apply contractual guidelines, and drive timely resolutions to meet collection goals.

This remote role requires residency in Florida or listed states and emphasizes accurate Epic data entry, denial analysis, and strong customer service aligned with our

Qualifications

• Resolve open receivables by researching unpaid, underpaid and denied claims.
• Apply billing guidelines to ensure timely resolution and meet collection goals.
• Maintain accurate documentation of claim follow up activities.

Responsabilités

• 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.

Formation

High School Diploma

Outils

Epic Systems

Description du poste

Nemours Children's Health in Jacksonville, FL is seeking a Medical Reimbursement Specialist to resolve open insurance balances through diligent claim follow-up and coding/billing review. You will research unpaid, underpaid, and denied claims, apply contractual guidelines, and drive timely resolutions to meet collection goals.

This remote role requires residency in Florida or listed states and emphasizes accurate Epic data entry, denial analysis, and strong customer service aligned with our