Coding and Billing Specialist

Assesses documentation for each service rendered in the hospital’s place of service, in order to accurately code principal diagnoses (i.e. preponderance of care sequence), secondary conditions, procedures, and social determinant codes using American Hospital Association guidelines, Current Procedural Terminology guidelines, payer specific rules for commercial and/or Medicaid insurance, and drug administration for specified service lines impacting Florida’s enhanced ambulatory grouping. This includes excellent working knowledge of revenue charge capture and the impact to hospital billing (i.e. soft vs. hard coded charges),working knowledge of revenue codes, relevant grouper function and financial impact; assessment and entry of surgical charges (i.e. supplies, implants), and pharmacy charges (i.e. contrast, patient supplied, etc).

Responsibilities

1. Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.

2. Meets minimum requirements for production and quality monthly.

3. Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.

4. Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.

5. Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.

6. Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)

7. Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.

8. Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).

9. Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Qualifications

1. Minimum education of an Associate's degree required
2. Medical Terminology, Anatomy and Physiology required

3. One of the following certifications required: CPC, CCS, RHIT, RHIA, COC (please include on resume)

Company

Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware and Nemours Children’s Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. duPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we’re on a journey to discover better ways of approaching children’s health. Putting as much focus on prevention as cures and working hand in hand with the community to make every child’s world a place to thrive. It’s a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All of our associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

To learn more about Nemours Children’s and how we go well beyond medicine, visit us at www.nemours.org.