Medical Reimbursement Analyst Sr

The primary function of the Senior Medical Reimbursement Analyst is the resolution of open high dollar insurance balances through collections. The position is responsible for researching unpaid, underpaid and denied high dollar insurance claims then applying contractual billing and payment guidelines to ensure timely resolution and meet collection goals. The position also uses knowledge of the revenue cycle to analyze, report and work reimbursement issues with various internal departments and external entities at all levels to create reliable methods for future resolution.

Essential Functions

• Work accounts until all charges are paid or denied by the insurance carrier, while utilizing their ability to multitask, maintain process efficiencies and production levels.
• Understand and apply principles of reimbursement to all aspects of the revenue cycle including but not limited to billing, coding, reimbursement, recovery, and patient responsibility.
• Account for high dollar balances and keep abreast of insurance trends while identifying and reporting payor trends and issues to management and huddle board in order to affect timely resolution.
• Pursue payment from payors related to both denials and underpayment through various means of communication including verbal and written platforms i.e email, appeals, etc.
• Accurately enter patient demographics, guarantor and coverage information into Epic system. As well as, accurately perform retro adjudication, change filing order, request necessary adjustments / reversal of adjustments, or refile claims.
• Apply problem solving skills to resolve discrepancies while maintaining a professional demeanor that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours when working with either insurers or the insured.
• Work jointly with all departments along the revenue cycle to resolve issues, including attending meetings both internally and externally. Building relationships which could result in an increase of collection % as well as, ensure timely processing of claims.
• Keep abreast of all insurance and system changes, Payor Plan Standards, contractual updates, etc.
• Apply balance adjustments as appropriate and accurately bill the guarantor for patient responsibility if applicable.

Requirements

High School Diploma

1-3 years of 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 .