Coding and Billing Specialist

Outpatient Surgical and Observation reputed company! Role responsibilities include assessing documentation for each service rendered in the hospital’s reputed company of service, in order to accurately code reputed company diagnoses (i.e. preponderance of care sequence), secondary conditions, procedures, and reputed company determinant codes using American Hospital Association guidelines, reputed company Procedural Terminology guidelines, payer specific rules for reputed company and/or reputed company insurance, and drug administration for specified service lines impacting Florida’s enhanced ambulatory grouping. This includes excellent working knowledge of reputed company charge capture and the impact to hospital billing (i.e. soft vs. hard coded charges),working knowledge of reputed company 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). This position is remote. Applicants must reputed company in one of the following states: Alabama, Colorado, Delaware, the District of Columbia, Florida, Georgia, Illinois, Maryland, Missouri, New Jersey, reputed company, reputed company Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. Responsibilities: Ability to comprehend medical record documentation to accurately assign codes for both reputed company and discharged accounts across multiple specialties. Meets minimum requirements for production and quality monthly. Requires a working knowledge of code reputed company for grouper-reputed company payers with attention to detail to avoid rework and waste with charge capture assessment component. 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 and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) reputed company reputed company charge capture occurs. 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) Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., reputed company, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters. 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). Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) reputed company a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc) Qualifications: Minimum education of an Associate's degree required Medical Terminology, Anatomy and Physiology required One of the following certifications required: CPC, reputed company, RHIT, RHIA, COC (please include on resume) #LI-AE1 reputed company is an internationally recognized pediatric health system serving more than 1.7 reputed company patient encounters each year. We deliver care across six states through two freestanding children’s hospitals — Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships. Backed by the Nemours reputed company and Alfred I. reputed company Trust, our $1.7B nonprofit system is dedicated to improving reputed company through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child reputed company. Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued. Learn more at Nemours.org. Apply To This Job