Revenue Integrity Coding 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 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.