Coding and Billing Specialist

Nemours; Orlando (FL); On-site; USD 55,000 - 70,000; Full time

Job summary

Nemours in Orlando, FL is seeking a Coding and Billing Specialist to assess documentation for each service rendered, accurately code principal diagnoses, secondary conditions, procedures, and social determinant codes using AHA guidelines, CPT, and payer rules, with emphasis on Florida’s enhanced ambulatory grouping.

This role requires strong knowledge of revenue charge capture, charge interpretation, and hospital information systems to retrieve data across complex filing schemes.

Qualifications

• Associate's degree required.
• Medical Terminology, Anatomy and Physiology.
• One of CPC, CCS, RHIT, RHIA, COC; CRC preferred.
• 3-5 years experience.

Responsibilities

• Code diagnoses, procedures, and charges across multiple specialties.
• Meet production and quality targets monthly.
• Apply code sequencing for grouper-related payers with attention to detail.
• Use ICD-10 CM coding data to capture diagnoses.
• Identify missing charges before encounter completion; analyze high-risk encounters.
• Incorporate payer trends to reduce take backs and ensure substantiation.
• Maintain ICD-10 CM, CPT-4, and modifier knowledge; pursue CCS/CPC/RHIT/RHIA certification.
• Assist in documentation queries to ensure level of service.
• Navigate hospital information systems to retrieve data within complex filing schemas.

Skills

Medical coding

Billing

ICD-10 CM

CPT-4 coding

Modifier application

Revenue capture

Charge entry

Query management

Code sequencing

Education

Associate's degree

Job description

Nemours is seeking a Coding and Billing Specialist in Orlando, FL

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).

Essential Functions

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)

Requirements

• Associate's degree required
• Medical Terminology, Anatomy and Physiology
• One of the following: CPC, CCS, RHIT, RHIA, COC; Preferred CRC
• 3-5 years experience