Sr. Coding and Billing Specialist at Nemours in Orlando, Florida

Job Description:

Nemours is seeking a Sr. Coding and Billing Specialist (FULL-TIME), for our Nemours Children's Hospital team in Orlando, Florida.

Located in Orlando, Fla., Nemours Children's Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the area's only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children's Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region.

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.

• Ability to comprehend medical record documentation to accurately assign codes for each active session, in multiple specialties.
• Meets minimum requires for production and quality monthly for 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.
• 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) where manual charge capture occurs.
• Understands 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 code for hospital and professional sessions routinely as part of the daily work.
• 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.).

• High School Diploma required with 1 year of specialized training beyond high school.
• Minimum of three (3) years experience required.
• RHIA, RHIT, or CCS required.
• CRC preferred.
• Knowledge of all state and federal regulatory requirements associated with billing and coding.