Reimbursement Specialist

Nemours is seeking a Reimbursement Specialist to join our team in Jacksonville, Florida.

As one of the nation's premier pediatric health care systems, Nemours provides world-class clinical care in four states -- Delaware, Florida, New Jersey and Pennsylvania. In Jacksonville, the Nemours Children's Clinic offers primary care physicians and families a much needed resource for children with complicated health issues. Affiliated with Wolfson Children's Hospital, we serve children from northeast Florida and southeast Georgia. Nemours is a fully integrated system of care which includes the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware - named one of the 25 Best Children's Hospitals by Parents magazine in 2009.

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.

Additional Responsibilities:

• 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.

Nemours, an equal opportunity employer, is committed to focusing on the best-qualified applicants for our openings.

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