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.
Nemours is seeking an Insurance Specialist (Full-Time), to join our Nemours Children's Hospital team in Orlando, Florida.
Located in Orlando, Fla., Nemours Children’s Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region.
The Primary function of the Insurance Specialist evaluates a patient’s insurance status and assist with ensuring eligibility of coverage for timely and efficient billing. This evaluation includes accessing our partner hospital’s electronic health record by checking for insurance eligibility. The associate continuously monitors the account until it is placed in appropriate insurance, or eligible charity care programs.
The Insurance Specialist ensures all pertinent demographic and insurance information is available and accurately documented. These activities include contacting guarantors to obtain information, communication with partner hospitals, and learning our partner hospital’s electronic health record software for continuous monitoring of accounts for proper documentation, insurance verifications, and collection of deposits and self-pay balances. This associate may be required to be subject to background checks for our partner hospitals to provide them with access to their electronic health record.
Protects the financial standing of Nemours by performing methodical and thorough financial assessments of our uninsured and/or underinsured patients assisting in applications for federal, state and local programs.
Accessing partner hospital’s electronic health record system for monitoring updates regarding coverage.
Verifies and assures all accounts are ready for billing with adequate supporting documentation, within the established time frames.
Serves as support to patients and their family members to assure patients have access to all available funding, this involves; working with private as well as governmental agencies; i.e., private insurance, HMO/PPO’s, Medicaid, Medicare, Champus, and Third Party Liability payers.
Initiates and completes charity applications on accounts at risk, for completing Medicaid application requirements and installment agreements. This includes Nemours Financial Assistance Programs.
Maintains daily contact with Utilization Management, Business Office, Patient Registration, Medical Records, Ancillary departments, various third-party agencies, HMO/PPO’s, patients, their families, physicians, offices and other outside entities.
Ensure compliance with hospital financial resolution policies, including conducting financial interviews with patients and families to assist with resolution of their account.
Aid in customer service resolution with concerns in regards to financial services. Including but not limited to giving advice and counsel to patients and guarantors of their rights, responsibilities, and procedures about payment for care.
Discuss insurance coverage and any expected patient responsibility. Aid in creating estimates for patient responsibility portion.
Communicates on behalf of financial services with other specialty clinic locations and physician offices.
Handles inbound and outbound calls including but not limited to pre and post service collections, customer service calls and account inquiries.
Responsible for Quality Integrity related work revolving around Accounts Receivable & Self Pay Process.
Associate’s Degree required or equivalent years of experience can be substituted in lieu of degree.
Minimum of three (3) years experience required.
Hospital experience and working knowledge of patient accounting functions including pre-admissions and admission registration preferred.
Minimum of 1 year Financial Counseling experience or equivalent required.
Demonstrates experience in credit, collection and billing is required, preferably in a hospital setting.
Must have excellent interpersonal and telephone skills.â‹
â‹***EXTERNAL CANDIDATES: Please be advised if you apply to this position, you will be asked to take an assessment as part of the application process. This could add an additional 20 to 45 minutes, based upon the assessment that corresponds with this position. Please allow yourself enough time to complete the test, as you will not be able to save your application and come back to complete it at a later time. Do not use your mobile phone to apply to this position; our assessment is not compatible with mobile devices at this time ***
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 committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.