Coding and Billing Specialist
About The Position
Nemours is seeking a Coding and Billing Specialist in Orlando, FL. This role involves assessing documentation for each service rendered in the hospital’s place of service to accurately code principal diagnoses, secondary conditions, procedures, and social determinant codes using American Hospital Association guidelines, Current Procedural Terminology guidelines, and payer-specific rules for commercial and/or Medicaid insurance. The specialist will also handle drug administration for specified service lines impacting Florida’s enhanced ambulatory grouping. This includes a strong understanding of revenue charge capture and its impact on hospital billing, revenue codes, grouper function, financial impact, and the assessment and entry of surgical and pharmacy charges.
Requirements
- Associate's degree required
- Medical Terminology, Anatomy and Physiology knowledge
- One of the following certifications: CPC, CCS, RHIT, RHIA, COC
Nice To Haves
- Preferred CRC certification
Responsibilities
- Assess documentation for each service rendered to accurately code principal diagnoses, secondary conditions, procedures, and social determinant codes.
- Apply American Hospital Association guidelines, Current Procedural Terminology guidelines, and payer-specific rules for commercial and/or Medicaid insurance.
- Manage drug administration coding for specified service lines impacting Florida’s enhanced ambulatory grouping.
- Demonstrate excellent working knowledge of revenue charge capture and its impact on hospital billing.
- Assess and enter surgical charges (supplies, implants) and pharmacy charges (contrast, patient supplied, etc.).
- Comprehend medical record documentation to accurately assign codes for concurrent and discharged accounts across multiple specialties.
- Meet minimum requirements for production and quality monthly.
- Apply code sequencing for grouper-related payers with attention to detail to avoid rework and waste.
- Analyze high-risk encounters for accurate or missing charges prior to encounter completion.
- Incorporate payer-specific trends into day-to-day reviews to reduce take-backs.
- Apply ICD 10 CM, CPT 4, and modifier application.
- Facilitate modifications to clinical documentation through query interaction to ensure captured information supports the level of service rendered.
- Retrieve data specific information from hospital information systems within a complicated filing schema.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
