As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
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.
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 retro adjudication, 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.
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.
High School Diploma required.
Minimum of one (1) to three (3) years' experience required.
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is a pediatric health system of hospitals and specialty clinics serving children and families throughout the Delaware Valley and Florida. Our dedicated professionals integrate medical care, research, health education, and prevention to help improve the lives of children every day.