Coding and Billing Specialist

Orlando, FL - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Description

Assesses documentation for each service rendered in the hospitals place of service in order to accurately code principal diagnoses (i.e. preponderance of care sequence) secondary conditions procedures and 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 impacting Floridas enhanced ambulatory grouping. This includes excellent working knowledge of revenue charge capture and the impact to hospital billing (i.e. soft vs. hard coded charges)working knowledge of revenue 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).

Responsibilities:

Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
Meets minimum requirements for production and quality monthly.
Requires a working knowledge of code sequencing for grouper-related 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) when manual 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. varyingmodifier 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. CCS 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) within a complicated filing schema including non-hospital data (i.e. Media Tab Office Visits etc)

Qualifications:

Minimum education of an Associates degree required
Medical Terminology Anatomy and Physiology required
One of the following certifications required: CPC CCS RHIT RHIA COC (please include on resume)

Required Experience:

DescriptionAssesses documentation for each service rendered in the hospitals place of service in order to accurately code principal diagnoses (i.e. preponderance of care sequence) secondary conditions procedures and social determinant codes using American Hospital Association guidelines Current Proc...

Description

Responsibilities:

Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
Meets minimum requirements for production and quality monthly.
Requires a working knowledge of code sequencing for grouper-related 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) when manual 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. varyingmodifier 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. CCS 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) within a complicated filing schema including non-hospital data (i.e. Media Tab Office Visits etc)

Qualifications:

Minimum education of an Associates degree required
Medical Terminology Anatomy and Physiology required
One of the following certifications required: CPC CCS RHIT RHIA COC (please include on resume)

Required Experience:

Key Skills

Apply Now

About Company

The Nemours Foundation

Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware an ... View more

View Profile View Profile

AI AutoApply

Apply to 100+ jobs with one click