Coding and Billing Specialist

Nemours Children's Health • Orlando, FL

13h • $22 - $33

About The Position

Nemours is seeking a Coding and Billing Specialist in Orlando, Florida. The role assesses documentation for services rendered in the hospital setting to accurately code principal and secondary diagnoses, procedures, and social determinant codes. The specialist applies American Hospital Association and Current Procedural Terminology guidelines, payer-specific rules for commercial and Medicaid insurance, and drug-administration coding for service lines that affect Florida’s enhanced ambulatory grouping.

The position requires working knowledge of revenue charge capture and its impact on hospital billing, including soft versus hard coded charges, revenue codes, grouper functions and financial impact. It also includes assessing and entering surgical charges such as supplies and implants, and pharmacy charges such as contrast and patient-supplied items. The specialist reviews records across multiple specialties and supports accurate billing through charge-gap analysis, payer-aware coding, and clinical documentation queries.

Requirements

• Associate's degree.
• Knowledge of medical terminology, anatomy, and physiology.
• One of the following certifications: CPC, CCS, RHIT, RHIA, or COC.
• 3–5 years of experience.

Nice To Haves

• CRC certification preferred.

Responsibilities

• Review medical record documentation and accurately assign codes for concurrent and discharged accounts across multiple specialties.
• Meet monthly minimum production and quality requirements.
• Apply code sequencing knowledge for grouper-related payers and assess charge capture carefully to prevent rework and waste.
• Apply M.E.A.T. criteria (monitoring, evaluation, assessment, and treatment) to capture diagnoses using the ICD-10-CM transaction data set.
• Analyze high-risk encounters for accurate or missing charges before encounter completion, including charges from anesthesia and surgery when manual charge capture is used.
• Apply payer-specific billing requirements and trends in daily reviews to reduce takebacks related to unclear or unsubstantiated care, including modifier assignment differences for EAPG and non-EAPG payers.
• Use ICD-10-CM, CPT 4, and modifiers, and maintain a relevant coding certification while applying inpatient and outpatient ICD-10-CM coding guidelines.
• Facilitate clinical documentation modifications through queries so captured information supports the level of service rendered, with attention to chronic conditions, HCC, and RAF.
• Use hospital information systems to retrieve relevant data, such as order diagnoses and patient type, from complex filing structures, including non-hospital records such as media tabs and office visits.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree