Senior Medical Reimbursement Analyst
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Job Description
Senior medical reimbursement analyst resolving high-dollar insurance claims and reimbursement issues. Supporting Nemours Children’s Health, a pediatric health system serving patients across six states.
Responsibilities:
- Resolve open high-dollar insurance balances through collections.
- Research unpaid, underpaid, and denied high-dollar insurance claims and apply contractual billing and payment guidelines.
- Work accounts until charges are paid or denied by the insurance carrier while maintaining process efficiency and production levels.
- Apply reimbursement principles across billing, coding, reimbursement, recovery, and patient responsibility.
- Track high-dollar balances and identify and report payer trends and issues to management and huddle board.
- Pursue payment from payers for denials and underpayments through email, appeals, and other communication methods.
- Enter patient demographics, guarantor, and coverage information into Epic.
- Perform retro adjudication, change filing order, request adjustments or reversals, and refile claims.
- Resolve discrepancies and maintain professional interactions with insurers and insured patients.
- Collaborate with revenue-cycle departments and attend internal and external meetings.
- Maintain awareness of insurance and system changes, payer plan standards, and contractual updates.
- Apply balance adjustments and bill guarantors for patient responsibility when applicable.
Requirements:
- High school diploma
- 1 year of experience
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