Reimbursement Specialist-Nemours Home Office
Company: Nemours Foundation
Posted on: January 27, 2023
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 * 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
* Accurately enter patient demographics, guarantor and coverage
information into Epic system.
* Accurately perform retro adjudication, change filing order,
request necessary adjustments / reversal of adjustments, or refile
* Distribute payments for assigned financial class to ensure
payments are posted to correct service dates and request changes if
* Identify and report payor trends and issues in order to effect
* 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. Performance Skills: * Working knowledge in
medical insurance billing guidelines required.
* Experienced in using reference materials: CPT, ICD9, HCPCS, CMS
Guidelines, NCCI and Anesthesia reference materials.
* Demonstrate professional conduct with both internal and external
* Ability to recognize and uphold confidentiality requirements
expected by the Nemours Foundation.
* Works independently or as a team, takes direction, prioritizes,
makes decisions, and accepts feedback with the willingness to
accept change. Job Requirements * High School Diploma required.
* Minimum 1 year experience in Physician Billing. Medicaid billing
a plus with use of Medicaid portals.
* knowledge of EPIC system a plus.
* Knowledge of billing CPT Codes and Dx Codes a plus.
* Must have billing knowledge of at least 2 years.
* 1-3 years of job-related experience.
Keywords: Nemours Foundation, Jacksonville , Reimbursement Specialist-Nemours Home Office, Other , Jacksonville, Florida
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