Professional Fee Abstractor

Nemours; Pensacola (FL); Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is looking for a detail-oriented Professional Fee Abstractor to join their remote team. In this role, you will assess medical claims, applying M.E.A.T. criteria to ensure accurate coding of ICD 10 CM, CPT, and HCPCS codes. You will collaborate with healthcare providers and staff to maintain high standards of coding accuracy and productivity. The ideal candidate will have a strong background in medical coding, relevant certifications, and a commitment to quality. This is an exciting opportunity to contribute to a leading healthcare organization dedicated to improving children's health.

Qualifications

• 3-5 years of relevant experience in medical coding.
• Certification in CCS-P, CPC, RHIA, or RHIT is required.

Responsibilities

• Code between 60-100 sessions per shift accurately.
• Collaborate with providers to ensure accurate coding of claims.

Skills

ICD 10 CM codes

CPT codes

HCPCS codes

medical record documentation

charge capture accuracy

Education

High School Diploma

Associate’s Degree

Tools

M.E.A.T. criteria

billing and coding regulations

Job description

Nemours is seeking a Professional Fee Abstractor, Full-Time, to join our Nemours Children's Health team.

This is a REMOTE position.

Assess each professional session (claim) for documented conditions and apply M.E.A.T. criteria (monitoring, evaluation, assessment, treatment) to accurately assign ICD 10 CM codes, evaluation & management CPT codes, procedure codes, HCPCS codes, and modifiers according to payer guidelines.

1. Understand medical record documentation to assign codes for active sessions across multiple specialties, with codes evaluated and modified with provider approval.
2. Code between 60-100 sessions per shift, with daily completion of “Coding Required” sessions due to variable line counts per session.
3. Collaborate with providers, allied health staff, and business office staff to accurately code approximately 1500 claims.
4. Analyze high-risk encounters for charge capture accuracy and recommend adjustments before second-level review.
5. Assist in modifying clinical documentation to support services, focusing on chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
6. Incorporate payer-specific billing trends into daily reviews to minimize “take backs” from unclear or unsubstantiated care.
7. Perform crossover coding for all professional sessions as assigned, using standardized methods per session type.
8. Communicate with providers for clarification or documentation gaps before coding to ensure services are accurately represented.
9. Maintain productivity and accuracy metrics as set annually.

Job Requirements

• High School Diploma required; Associate’s Degree preferred.
• 3-5 years of relevant experience required.
• Certification in CCS-P, CPC, RHIA, or RHIT is required.
• CRC or CEMC certification is preferred.
• RCC or other qualifying specialty certification is desirable.
• Knowledge of state and federal billing and coding regulations is essential.