Medical Reimbursement Specialist

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    "ExternalDescriptionStr": "<p style=\"background-color: white;\"><span style=\"color: rgb(51, 51, 51); font-family: Helvetica, sans-serif;\"><span style=\"font-size: 10.5pt;\"><strong>Job Description</strong></span></span></p><p><span style=\"color: rgb(51, 51, 51); font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">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</span></span></p><ul style=\"list-style-type: disc;\"><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Work accounts / invoices until all charges are paid or denied by the insurance carrier.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Process insurance / patient correspondence, deductibles, medical records request, non-covered services, adjustments and appeals.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Process request for adjustments, account type changes, guarantor merges, and transfers when necessary, according to enterprise guidelines.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Accurately enter patient demographics, guarantor, and coverage information into Epic system.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Accurately perform retro adjudication, change filing order, request necessary adjustments / reversal of adjustments, or refile claims.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Distribute payments for assigned financial class to ensure payments are posted to correct service dates and request changes if needed.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Identify and report payor trends and issues in order to effect timely resolution.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Know and use data entry ground rules, Standard Business Practice, Nemours Intranet, Managed Care Manual and where to locate any hard copy or electronic versions.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Keep abreast of all insurance and system changes, Payor Plan Standards, Just in Time Learning’s, News to Use, etc.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Demonstrate excellent customer service that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours.</span></span></li></ul><p><span style=\"color: rgb(51, 51, 51); font-family: &quot;Segoe UI&quot;, sans-serif;\"><i><span style=\"font-size: 10.5pt;\"><strong><u>Performance Skills:</u></strong></span></i></span></p><ul style=\"list-style-type: disc;\"><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Working knowledge in medical insurance billing guidelines required.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Experienced in using reference materials: CPT, ICD10, HCPCS, CMS Guidelines, NCCI and Anesthesia reference materials.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Demonstrate professional conduct with both internal and external customers.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Ability to recognize and uphold confidentiality requirements expected by the Nemours Foundation.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Works independently or as a team, takes direction, prioritizes, makes decisions, and accepts feedback with the willingness to accept change.&nbsp;</span></span></li></ul><p><span style=\"color: rgb(51, 51, 51); font-family: &quot;Segoe UI&quot;, sans-serif;\"><i><span style=\"font-size: 10.5pt;\"><strong><u>Job Requirements</u></strong></span></i></span></p><ul style=\"list-style-type: disc;\"><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">High School Diploma required.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Billing a plus with use of payor portals.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Knowledge of EPIC system a plus.</span></span></li><li style=\"color: rgb(51, 51, 51);\"><span style=\"font-family: &quot;Segoe UI&quot;, sans-serif;\"><span style=\"font-size: 10.5pt;\">Knowledge of billing CPT Codes and Dx Codes a plus.</span></span></li></ul>",
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    "CorporateDescriptionStr": "<p style=\"margin:0in 0in 0in 42pt\">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.</p>\n<p style=\"margin:0in 0in 0in 42pt\"><br></p>\n<p style=\"margin:0in 0in 0in 42pt\">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.</p>\n<p style=\"margin:0in 0in 0in 42pt\"><br></p>\n<p style=\"margin:0in 0in 0in 42pt\">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.</p>\n<p style=\"margin:0in 0in 0in 42pt\"><br></p>\n<p style=\"margin:0in 0in 0in 42pt\">Learn more at <a href=\"https://www.nemours.org\" target=\"_blank\">Nemours.org</a>.</p>",
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