Medical Reimbursement Specialist

Nemours Children's Health • Jacksonville, FL

4d

About The Position

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, Florida. The primary function of this position is resolving open insurance balances through collections. The specialist researches unpaid, underpaid, and denied insurance claims and applies contractual billing and payment guidelines to ensure timely resolution and meet collection goals.

The role reviews coding, billing, contract agreements, and authorization terms; identifies rejection and denial trends; documents claim follow-up activities; responds to customer service inquiries; and handles denials and underpayments through appeals or adjustments. The specialist also maintains accurate patient, guarantor, and coverage information in Epic, manages filing order and payment distribution, and follows standard business practices and enterprise guidelines while providing excellent customer service.

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters annually across six states. The nonprofit system provides clinical care, research, education, advocacy, and prevention, with a Whole Child Health approach. Nemours is committed to inclusion and belonging, culturally relevant care, reducing health disparities, and supporting associates, patients, and families.

Requirements

• High school diploma.
• 1–3 years of experience.

Responsibilities

• Resolve open receivables by reviewing coding, billing, contract agreements, and authorization terms.
• Diagnose and report rejection and denial trends to management.
• Maintain accurate documentation of claim follow-up activities.
• Respond to customer service inquiries and process requests for adjustments, account type changes, guarantor merges, and transfers according to enterprise guidelines.
• Address insurance denials and underpayments by appealing or adjusting balances as appropriate and accurately billing guarantors for patient responsibility.
• Enter patient demographics, guarantor information, and coverage information accurately into Epic.
• Change filing order, ensure necessary adjustments are listed on accounts, distribute payments to the correct service dates, and request changes when needed.
• Keep abreast of insurance and system changes, use standard business practices, and provide customer service that promotes patient, staff, and customer satisfaction and reflects Nemours’ Mission, Vision, and Values.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED