Professional Fee Abstractor

Nemours

  • Pensacola, FL
  • Permanent
  • Full-time
  • 1 month ago
Job Description:Nemours is seeking a Professional Fee Abstractor (Coder), Full-Time, to join our Nemours Children's Health team.Assesses each professional session (i.e. claim) for all documented conditions and application of M.E.A.T. criteria (i.e. monitoring, evaluation, assessment, treatment) to accurately apply ICD 10 CM codes to capture diagnoses, evaluation & management CPT codes, procedure codes, HCPCS codes and modifier application per payer specific guidelines.
  • Ability to comprehend medical record documentation to assign codes for each active session, in multiple specialties. (i.e. Codes assigned by provider are evaluated and modified with the approval of the provider)
  • Codes a minimum of 60-100 sessions per shift. The number of lines per session varies, therefore, “Coding Required” sessions are completed daily.
  • Works collaboratively in a team setting with providers, allied health staff, business office staff throughout the enterprise to achieve accurately coded 1500 claims.
  • Analyzes high-risk encounters for accurate charge capture and makes recommendation before transferring to second level review work queues.
  • Facilitates modifications to clinical documentation to ensure that information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC) and risk adjustment factors (RAF).
  • Understands complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, nonspecific, or un-substantiated care rendered.
  • Crossover coding is expected to help in any and all professional sessions (as assigned) using written reliable methods which identifies standard work requirements by session type.
  • Communicates with providers directly for clarification or gaps in documentation prior to submitting the session to assign the code(s) which fit services rendered.
  • Maintains production and accuracy objectives (i.e. metrics) identified annually.
Job Requirements
  • High School Diploma required. Associate's Degree preferred.
  • Minimum of three (3) to five (5) years experience required.
  • One of the following is required: CCS-P, CPC, RHIA, OR RHIT
  • CRC, CEMC preferred.
  • RCC or other qualifying specialty certification
  • Knowledge of all state and federal regulatory requirements associated with billing and coding.
About Us:As one of the nation's premier pediatric health care systems, we've made a promise to do whatever it takes to prevent and treat even the most disabling childhood conditions. It's a promise that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention.Equity, diversity, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive environment. All Nemours Associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.Nemours aspires to have its workforce and providers reflect the rich diversity of the communities we serve. Candidates of diverse backgrounds, race and ethnicity, religion, age, gender, sexual orientation, and those committed to working with diverse populations and conversant in multicultural values are strongly encouraged to apply. Please click here to review .To learn more about Nemours and our commitment to treat every child as if they were our own, visit us at .

Nemours