Medical Reimbursement Specialist

Job Description

Nemours is seeking a Medical Reimbursement Specialist in Jacksonville, FL

This position is responsible for effective follow up on accounts / invoices for assigned Payors resulting in payment or final adjustment. Proficiency in assigned Payors billing and payment guidelines is required, to ensure the departmental collection goals are met or exceeded as established by management.

Essential Functions

• Work accounts / invoices until all charges are paid or denied by the insurance carrier.
• Process insurance / patient correspondence, deductibles, medical records request, non-covered services, adjustments and appeals.
• Process request for adjustments, account type changes, guarantor merges, and transfers when
  
  

necessary according to enterprise guidelines.

• Accurately enter patient demographics, guarantor and coverage information into Epic system.
• Accurately perform retroadjudication, change filing order, request necessary adjustments /
  
  

reversal of adjustments, or refile claims.

• Distribute payments for assigned financial class to ensure payments are posted to correct service
  
  

dates and request changes if needed.

• Identify and report payor trends and issues in order to effect timely resolution.
• Know and use data entry ground rules, Stand Business Practice, Nemours Intranet, Managed
  
  

Care Manual and where to locate any hard copy or electronic versions.

• Keep abreast of all insurance and system changes, Payor Plan Standards, Just in Time
  
  

Learning’s, News to Use, etc.

• 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 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 .