Reimbursement Specialist-CBO-Hospital at Nemours in Jacksonville, Florida

Job Description:

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 -

1. Work accounts / invoices until all charges are paid or denied by the insurance carrier.

2. Process insurance / patient correspondence, deductibles, medical records request, non-covered services, adjustments

and appeals.

3. Process request for adjustments, account type changes, guarantor merges, and transfers when necessary according

to enterprise guidelines.

4. Accurately enter patient demographics, guarantor and coverage information into Epic system.

5. Accurately perform retro adjudication, change filing order, request necessary adjustments / reversal of adjustments,

or refile claims.

Requirements:

• High School Diploma Required
• Working knowledge in insurance billing guidelines and requirements.
• Experienced in using reference materials: CPT, ICD9, HCPCS, CMS Guidelines, NCCI and Anesthesia reference materials.
• Demonstrate professional conduct with both internal and external customers.
• 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.