Coding and Billing Specialist Sr

Nemours Children’s Hospital, Florida is seeking a Coding & Billing Specialist Sr. (FULL-TIME REMOTE), to join our Orlando, FL team.

Responsible for assessing documentation content for service(s) rendered in the hospital setting and professional setting in order to accurately code principal diagnoses, secondary conditions, procedures, social determinant codes using American Hospital Association guidelines, Current Procedural Terminology codes, payer specific rules for commercial and/or Medicaid insurance, and drug administration for specified service lines.

Exhibits unique talent and comprehension for assessment of each encounter/session in order to cross from Hospital to Professional lines of business to code or assess services which exist on the same date of service, in the same place of service (POS) – Examples Anesthesia, pathology, Assistant Surgeon, and Evaluation and Management leveling.

The Coding & Billing Specialist Sr will:

• Ability to comprehend medical record documentation to accurately assign codes for each active session, in multiple specialties for place of service outpatient.
• Meets minimum requires for production (3 per hour) for single path coding (i.e. all procedure/surgeries assigned a CPT code (hospital and professional).
• Requires a working knowledge of code sequencing for payer specific rules which requires attention to detail to avoid rework and waste. (e.g. Working knowledge of modifiers, medical necessity, high to low charge ratio for PB, and good working knowledge of the Enhanced Ambulatory Payment Grouping software which is used to calculate hospital reimbursement.
• 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.
• Analyzes high-risk encounters for accurate charge capture and charge gaps prior to encounter completion (i.e. missing charges from anesthesia, surgery, surgical assistant, pathology) where manual charge capture occurs repetitively.
• 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.
• Facilitates modifications to clinical documentation through concurrent 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).
• Ability to communicate succinctly with physicians and mid-level providers to assure codes assigned are in tandem with the physicians. Queries are generated as needed to specify clarity due to gaps in documentation.
• Exhibits proficiency in all surgical coding: Cardiac, ENT, General Surgery/GI, Neurosurgery, Orthopedics, Plastics, and Urology, with excellent working knowledge of hospital information system 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.).

Qualified Candidates will:

• Must have a High School Diploma.
• Minimum 5 years of experience.
• RHIA, RHIT, CCS, CPC Certifications required.
• CRC Certification preferred.
• Medical Terminology, Anatomy and Physiology, Pathophysiology preferred.