Nemours · 17 hours ago

Coding and Billing Specialist

Orlando, FL

Full-time

Remote

Mid Level

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Responsibilities

Assesses documentation for each service rendered in the hospital 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 Florida’s enhanced ambulatory grouping.

Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across, multiple specialties.

Meets minimum requires 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. 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. CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.

Facilitates 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 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)

Qualification

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ICD 10 CMCPT 4Coding GuidelinesCertification CCSCertification CPCCertification RHITCertification RHIACharge CaptureMedical Record DocumentationE.A.T. CriteriaHospital Information SystemModifier ApplicationRisk Adjustment Factors (RAF)Hierarchical Condition Categories (HCC)Payer Specific TrendsCharge Gaps Analysis

Required

Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.

Meets minimum requires 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. varying modifier assignment for EAPG vs. Non-EAPG payer specificity)

RHIA, RHIT, CCS, or CPC Required