Inpatient Hospital Coder

Nemours-Children; Orlando (FL); On-site; USD 65,000 - 90,000; Full time

Job summary

Nemours is seeking an Inpatient Hospital Coder in Orlando, FL. The role focuses on coding principal diagnoses, procedures, and social determinant codes per AHA guidelines, CPT and payer rules.

The coder will work across hospital and professional lines, ensuring accurate charge capture and compliant documentation. Requires 3–5 years of experience and relevant credentials.

Qualifications

• Associates degree preferred
• Medical Terminology and Anatomy & Physiology required
• CCS, RHIT, RHIA; CRC preferred

Responsibilities

• Assess documentation to assign codes for active sessions across specialties.
• Meet production and quality requirements for procedures and surgeries with CPT codes.
• Apply M.E.A.T. criteria using ICD-10-CM data to capture diagnoses.
• Analyze high-risk encounters for accurate charge capture and avoid rework.
• Code for hospital and professional sessions daily across lines of business.

Skills

CPT coding

ICD-10-CM

Payer rules

Charge capture

HCC/RAF

Hospital coding

MEAT criteria

Education

Associate's degree

Medical Terminology

Anatomy and Physiology

CCS/RHIT/RHIA; CRC preferred

Tools

Hospital information system

Job description

Nemours is seeking an Inpatient Hospital Coder in Orlando, FL

Responsible for assessing documentation content for service rendered in the hospital setting and/or professional setting in order to accurately code principal diagnoses, secondary conditions, procedures, 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. Exhibits unique talent and comprehension in order to assign codes for multiple encounter/session (i.e. single path coding ) from Hospital to Professional lines of business process services which exist on the same date of service, in the same place of service (POS) include service lines which have the same documentation but different code assignments (i.e. radiology) with focus on specific ordering practices.

Essential Functions

1. Ability to comprehend medical record documentation to accurately assign codes for each active session, in multiple specialties.

2. Meets minimum requires for production and quality monthly for all procedure/surgeries assigned a CPT code (hospital and professional)

3. Requires a working knowledge of code sequencing for payer specific rules which requires attention to detail to avoid rework and waste.

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 charge capture and charge gaps prior to encounter completion (i.e. missing charges from anesthesia, surgery) where 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.

7. 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).

8. Ability to code for hospital and professional sessions routinely as part of the daily work.

9. Exhibits proficiency in all surgical coding three or more surgery based product lines:Cardiac, ENT, General Surgery/GI, Neurosurgery, 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)

Requirements

Associate's degree preferred

Medical Terminology, Anatomy and Physiology

One of the following: CCS, RHIT, RHIA; Preferred CRC

3-5 years experience