Job Description

Nemours is seeking an Insurance Specialist, FULL-TIME, to join our team in Pensacola, Florida.

This is a hybrid position.

Utilizing high-level customer service, healthcare finance knowledge, and excellent communication skills, the Insurance Specialist will evaluate a patient’s insurance status and assist with ensuring eligibility of coverage for timely and efficient billing. The work includes accessing our partner hospital’s electronic health record to verify insurance eligibility. Continuously monitor accounts to place appropriate insurance, or eligible charity care programs to ensure timely filing.

The Insurance Specialist validates all pertinent demographic, and insurance information is available and accurately documented. Work involves 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. Associates may be required to be subject to background checks for our partner hospitals to provide them with access to their electronic health record.

Associate support and serve as a resource, which includes cross covering Family Financial Advocate functions within the team by providing cost estimates to patients and providers, and approving discounts in accordance with organizational and government policies.

Job Responsibilities:

• 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.
• Access partner hospital’s electronic health record system for monitoring updates regarding insurance coverage. Verify and assure all accounts are ready for billing with adequate supporting documentation, within the established time frames. Responsible for the quality-integrity related work revolving around Accounts Receivable & Self Pay Process.
• Supports 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, Kidcare, Medicare, Champus, and Third-Party Liability payers.
• 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 regarding 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.
• Create patient responsibility estimates based on the insurer’s coverage and benefit information, as well as collect applicable 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 customer service calls, account inquiries and coverage benefits and eligibility status.
• Convey courtesy, dignity, respect and a positive attitude through words and actions to establish harmonious relationships with all individuals. Demonstrate effective communication and respect by using active listening skills, positive body language and effective verbal, written and electronic forms of communication. Demonstrate care and concern and inclusion when interacting with and informing customers by consistently using A.I.D.E.T and protecting confidentiality and privacy.
• Responsible for the quality integrity related work revolving around Accounts Receivable & Self Pay Process.
• May support with scheduling functions, other projects, and duties as assigned by supervisor.

Job Requirements

• Associate’s Degree or equivalent of education, training, and experience required.
• Minimum (3) three years of hospital experience and working knowledge of patient accounting functions including pre-admissions and admission registration will be considered in lieu of an Associate Degree.
• Minimum (1) year of Family Financial Advocate experience, in addition to Registration, insurance, billing, and/or relevant experience required for FA I.
• Strong Customer service, communication, and problem-solving skills required.
• Knowledge of healthcare insurance, reimbursement methodologies, and revenue cycle operations required.
• Experience working with electronic health record (EHR) systems and patient account management preferred.

What We Offer

• Competitive base compensation in the top quartile of the market
• Annual incentive compensation that values clinical activity, academic accomplishments and quality improvement
• Comprehensive benefits: health, life, dental, vision
• 403B with employer match.
• Licensure, CME and dues allowance
• Not-for-profit status; eligibility for Public Service Loan Forgiveness
• For those living and working in Florida, enjoy the benefit of no state income tax. Those based in Delaware benefit from the state's moderate tax structure.

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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.