Medical Reimbursement Specialist

Nemours - Jacksonville, FL

Full-time

Jacksonville, FL

Hospitals

About the position

The Medical Reimbursement Specialist at Nemours is responsible for resolving open insurance balances through effective collections. This role involves researching unpaid, underpaid, and denied insurance claims, applying billing and payment guidelines to ensure timely resolution, and meeting collection goals. The position requires strong analytical skills and attention to detail to facilitate the resolution of receivables and maintain accurate documentation.

Responsibilities

• Facilitate resolution of open receivables by reviewing coding, billing, contract agreements, and authorization terms.
• Diagnose and report issues regarding rejection and denial trends to management.
• Maintain accurate documentation of claim follow-up activities.
• Address inquiries on customer service encounters, including process requests for adjustments and account type changes.
• Address insurance denials and underpayments, appealing and/or adjusting balances as appropriate.
• Accurately enter patient demographics, guarantor, and coverage information into the Epic system.
• Change filing order, ensure necessary adjustments are listed on accounts, and distribute payments to correct service dates.
• Keep abreast of all insurance and system changes and demonstrate excellent customer service.
• Attend meetings regarding assigned Payors and team/department updates.
• Assist insurance companies/guarantors with questions regarding charges and balances.
• Work with other departments to resolve issues affecting reimbursement.
• Perform other duties as assigned.

Requirements

• High School Diploma required.
• Minimum 1 year of experience required.