Medical Reimbursement Specialist

The Nemours Foundation • Jacksonville, FL

3d • Remote

About The Position

Nemours is seeking a Medical Reimbursement Specialist to resolve open insurance balances through collections. The position researches unpaid, underpaid, and denied insurance claims and applies contractual billing and payment guidelines to support timely resolution and meet collection goals. This is a remote position, and 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, or Virginia.

Requirements

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

Responsibilities

• Facilitate resolution of 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.
• Address inquiries on customer service encounters, including processing requests for adjustments, account type changes, guarantor merges, and transfers according to enterprise guidelines.
• Address insurance denials and underpayments by appealing and/or adjusting balances as appropriate, and accurately bill the guarantor for patient responsibility.
• Accurately enter patient demographics, guarantor, and coverage information into the Epic system.
• Accurately change filing order, ensure necessary adjustments are listed on accounts, distribute payments to the correct service dates, and request changes when needed.
• Use standard business practices and stay informed about insurance and system changes.
• Demonstrate 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