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Job Description: Coder, Health Information Management, CCS / Bachelor's (Coding, Records) Nemours is seeking a Coder to join our Nemours Children's Hospital team in Orlando, Florida. As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. Located in Orlando, Florida, Nemours Children’s Hospital is the newest addition to the Nemours integrated health care system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids and outpatient pediatric clinics, including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in health care innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region. Responsible for the facility coding and abstracting of all emergency department and hospital outpatient accounts according to established ICD-9-CM and CPT coding guidelines. The assigned codes are utilized for third-party reimbursement for services rendered at the Nemours Children's Hospital to maintain a clinical database to provide reports and to submit data to the Agency for Health Care Administration (i.e., State of Florida mandatory reporting). Ability to read and comprehend the medical record to help identify all diagnoses, operations and procedures relevant to the current period. Select, assign and sequence the appropriate ICD-10 Diagnosis and PCS and CPT codes to patients’ current period of care according to established sequencing guidelines for optimal reimbursement for the emergency department and inpatients. Abstract records in an accurate manner according to established procedures and guidelines (i.e., attending physician, consults, dates of procedure, surgeon, point of origin, admission source and birth weight). Contact the appropriate health care provider if there is inadequate information on which to base code assignment, or clarify inconsistent, doubtful or non-specific information in a medical record by querying the responsible physician. Coding knowledge of infusion hierarchy with knowledge of medications. Coding knowledge of modifier application based on HIM principles to include order validation, modifier validation and communication with revenue areas for validation of charges. Enter pending claims in the Abstracting Activity of Epic for reporting and follow-up. Validate that each outpatient encounter has a provider order for the service prior to coding. Use the Abstracting Activity function in Epic to track missing orders. Code outpatient/emergency department encounters of 125 daily; code 75 recurring rehabilitation encounters daily with a 95% accuracy rate. Code 2.5 inpatients per hour. Accuracy minimum is 95% accuracy within 12 months. Demonstrate and incorporate a working knowledge of the Epic for retrieval of clinical data for coding purposes, including comprehension of filing schema, Media tab and Office visit overlay for ordering. Participate in continuous improvement training and working towards an “error-free” environment. Understand and comply with Correct Coding Initiative edits for hospital/facility outpatient encounters. Have good working knowledge of medical necessity rules, local coverage determination policies and any other payer-specific guidelines. Requirements High school diploma with post-specialized training required. Certified Coding Specialist (CCS) certification or Bachelor's degree in HIM required. Minimum of one (1) to three (3) years' inpatient/outpatient coding experience preferred. Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings. Don’t miss out on important health care news and updates from Nemours – connect with us on… Facebook (Fan Page) | YouTube | Twitter | Flickr Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, Children, Child, Neonatal, Registered Health Information Administrator, Registered Health Information Technician, Technologist, RHIA, RHIT, Tech, Certified Medication Technician, Clerical, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC, AAPC, American Academy of Professional Coders

Job Description: Coder Billing Liaison, Full Time, Days, 3-5 Yrs Exp Req (RHIT, RHIA, CCS, Coder) Nemours is seeking a Coder Billing Liaison - Full Time to join our Nemours Children's Hospital team in Orlando, Florida. As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. Located in Orlando, Florida, Nemours Children’s Hospital is the newest addition to the Nemours integrated health care system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids and outpatient pediatric clinics, including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in health care innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region. Responsible for the facility charge capture and coding of all outpatient patient classes in a timely and accurate manner within key process indicators measures set for the department. Responsible for managing “handoffs” between work queues that are held with a question, a deficiency or gap to assess charge capture implications. All encounters are coded according to payer-specific guidelines and using the appropriate nomenclature transaction (code) sets, payer-specific guidelines, appropriate application of modifiers, and evaluation of charge capture for all items ordered. The assigned codes are utilized for third-party reimbursement for services rendered at the Nemours Children's Hospital to maintain a clinical database, to provide reports, and to submit data to the Agency for Health Care Administration (i.e., State of Florida mandatory reporting). Ability to read and comprehend the medical record to help identify all diagnoses, operations and procedures relevant to the current encounter documentation and orders. Acts like an auditor and confirms assignment of  CPT, modifiers and HCPCS codes to patients’ current period of care according to established sequencing guidelines for optimal reimbursement for all hospital outpatients (i.e., emergency, recurring, outpatients, outpatient surgery, observation and outpatient extended recovery encounters). Reviews charge capture techniques and identifies opportunities for improvement in charge capture processes. Attains good working knowledge of Enhanced Ambulatory Payment Groupings (EAPG). Trends potential gaps in documentation (by provider) if there is inadequate information on which to base code assignment and sends analysis monthly to Director of HIM. Coding knowledge of modifier application based on HIM principles to include order validation, modifier validation and communication with revenue areas for validation of charges. Demonstrates and incorporates a working knowledge of Epic for retrieval of clinical data for coding purposes, including comprehension of filing schema, media tab and office visit overlay for ordering. Participates in continuous improvement training and works towards an “error-free” environment. Understands and complies with Correct Coding Initiative edits for hospital/facility outpatient encounters. Have good working knowledge of medical necessity rules, local coverage determination policies and any other payer-specific guidelines. Requirements Associate's degree required (preferred undergraduate course of study: Health Information, Business Administration or Nursing). Minimum of three (3) to five (5) years experience required. AHIMA credential: RHIT, RHIA and/or CCS within 1 year of employment required. Ability to provide independent and critical thinking regarding data analysis. Ability to execute quantitative analysis using Excel. Knowledge of all state and federal regulatory requirements. Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings. Don’t miss out on important health care news and updates from Nemours – connect with us on… Facebook (Fan Page) | YouTube | Twitter | Flickr Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, Children, Child, Neonatal, Registered Health Information Administrator, Registered Health Information Technician, Technologist, RHIA, RHIT, Tech, Certified Medication Technician, Clerical, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC, AAPC, American Academy of Professional Coders, Finance, Financial, Billing

Job Description: Billing & Coding Manager, Health System, CPC Req, FT (Coder, Accounting) Nemours is seeking a Billing and Coding Manager - Full Time to join our team in Jacksonville, Florida. As one of the nation’s leading pediatric healthcare systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. At Nemours, each Associate plays a vital role in supporting the delivery of world-class pediatric care to the children we serve. The team based at our home office in Jacksonville, Florida, provides essential administrative, financial and technical support to Nemours operations across all locations. Manage and coordinate the daily workflows and operations related to billing and coding for physician services provided in North and Central Florida. The Billing and Coding Manager will work with the CBO billing teams, management and clinical operations to develop consistent processes to ensure billing and coding is accurate, timely and compliant, according to the guidelines set forth by Nemours Coding Compliance and Coding Integrity, CMS and all other regulatory entities. The Billing and Coding Manager must be a Certified Professional Coder with an extensive knowledge of CPT, ICD-10 and HCPCS Level II coding guidelines, as well a strong knowledge of surgical and E/M coding. Supervise and manage all billing, coding and charge review functions related to physician billing. Hire, counsel and recommend disciplinary action as necessary. Audit all staff monthly, ensuring that associate billing accuracy exceeds 95%. Evaluate charges entered for transmission to the claim for accuracy and completeness. Ensure that all standard billing practices and guidelines are followed. Responsible for creation and maintenance of billing policies and procedures that are clear and succinct in accordance with corporate and government billing and coding guidelines. Create payer-specific guidelines resource for billing staff. Work with Reimbursement, Denial Analyst and NHI to create charge review work queue rules to assist in clean claim submission and mitigate denials from the payors. Work closely with Billing and Coding Teams to provide immediate feedback and education on coding and billing rules and guidelines as trends are identified. Assist Billing and Coding Team and Supervisors with tracking and escalating trends through the appropriate huddle process. Work closely with managed care department and other leaders within the revenue cycle regarding denial management and charge capture opportunities. Research all billing inquiries from providers, coworkers and administrative staff. Assist customers with all billing questions that arise in a prompt, professional manner. Requirements Bachelor's degree preferred. Minimum of five (5) years experience required. Management experience in physician billing required. Certified Professional Coder (CPC) required. Must have the ability to work well with others. Good communication skills are required. Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings. Don’t miss out on important health care news and updates from Nemours – connect with us on… Facebook (Fan Page) | YouTube | Twitter | Flickr Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, Children, Child, Neonatal, AP, AR, Accounts Payable, Accounts Receivable, Collection, Collections, Accounting, Finance, Accountant, Financial, Billing, Payment, Bill, Insurance, A/R, A/P, GAAP, Generally Accepted Accounting Principles, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC, Lead, Leader, Manager, Manage, Supervisor, Supervisory, Coordinator, Coordinate

Job Description: Coder, Health Information Management, 8am-5pm, Mon-Fri (Days, RHIT, RHIA, CCS) Nemours is seeking a Coder (HIM), Full Time, Monday-Friday, 8 a.m. to 5 p.m., to join our Nemours Children's Hospital team in Orlando, Florida. As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. Located in Orlando, Florida, Nemours Children’s Hospital is the newest addition to the Nemours integrated health care system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids and outpatient pediatric clinics, including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in health care innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region. Responsible for the facility coding and abstracting of all emergency department and hospital outpatient accounts according to established ICD-9-CM and CPT coding guidelines. The assigned codes are utilized for third-party reimbursement for services rendered at the Nemours Children's Hospital to maintain a clinical database to provide reports and to submit data to the Agency for Health Care Administration (i.e., State of Florida mandatory reporting). Ability to read and comprehend the medical record to help identify all diagnoses, operations and procedures relevant to the current period. Select, assign and sequence the appropriate ICD-10 diagnosis and PCS and CPT codes to patients’ current period of care according to established sequencing guidelines for optimal reimbursement for the emergency department and inpatients. Abstract records in an accurate manner according to established procedures and guidelines. (i.e., attending physician, consults, dates of procedures, surgeon, point of origin, admission source and birth weight). Contact the appropriate health care provider if there is inadequate information on which to base code assignment, or clarify inconsistent, doubtful or non-specific information in a medical record by querying the responsible physician. Enter Pending claims in the Abstracting Activity of Epic for reporting and follow-up. Validate that each outpatient encounter has a provider order for the service prior to coding. Use the Abstracting activity function in Epic to track missing orders. Code outpatient/emergency department encounters of 125 daily; code 75 recurring rehabilitation encounters daily with a 95% accuracy rate. Code 2.5 inpatients per hour.  Demonstrate and incorporate a working knowledge of Epic for retrieval of clinical data for coding purposes, including comprehension of filing schema, Media tab and Office visit overlay for ordering. Participate in continuous improvement training and working towards an “error-free” environment. Understand and comply with Correct Coding Initiative edits for hospital/facility outpatient encounters. Have good working knowledge of medical necessity rules, local coverage determination policies and any other payer-specific guidelines. Requirements Associate's degree required. Certified Coding Associate (CCA) minimum with intent to secure CCS within 12 months/RHIT or RHIA. Minimum of one (1) to three (3) years' inpatient/outpatient coding experience required. Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings. Don’t miss out on important health care news and updates from Nemours – connect with us on… Facebook (Fan Page) | YouTube | Twitter | Flickr Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, Children, Child, Neonatal, Registered Health Information Administrator, Registered Health Information Technician, Technologist, RHIA, RHIT, Tech, Certified Medication Technician, Clerical, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC, AAPC, American Academy of Professional Coders

Job Description: Charge Capture Coordinator, Health Information, FT, Days (Coding, Coder, Records) Nemours is seeking a Charge Capture Coordinator (HIM) - Full Time to join our Nemours Children's Hospital team in Orlando, Florida. As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 280,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. Located in Orlando, Florida, Nemours Children’s Hospital is the newest addition to the Nemours integrated health care system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids and outpatient pediatric clinics, including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in health care innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region. The Charge Capture Special Projects Analyst works in conjunction with hospital revenue departments to ensure that all charges are entered into the EpicCare system within 4 days of date of service and identifies trends associated with missing revenue by writing Crystal reports to extract data from the Epic system. Once missed charges are identified, the Chargemaster Senior Analyst and/or the Senior Manager, Hospital Coding and Billing will ensure that an accurate CPT or HCPCS code is assigned. This includes tracing the charge back to the point of origin (i.e., system-generated charge; flow sheet-generated charge; Associate-generated charge) and assisting in developing countermeasure(s) to prevent future occurrences. Responsible for accurate charge capture of all operating room supplies and implants for each surgery performed. Generates and reviews weekly reports relevant to captured revenue for tracking purposes. Posts missed charges in Epic accurately. Attends all charge capture-related meetings and maintains matrix of charge capture workflows. Analyzes high-risk encounters for accurate charge capture of all ordered diagnostic tests with focus on Blood Bank, Laboratory, Cardiac Catheterization and Respiratory. Reconciles high-risk areas for missed revenue as it relates to dropping claims within 4 days. Works with each group a minimum of twice a week with an agenda, plan and documentation of achieved results. Reports trends or gaps in missed charge capture to HIM Management in writing weekly. Requirements Bachelor's degree required. Preferred undergraduate course of study: Health Information, Finance and/or Nursing. Minimum of one (1) to three (3) years experience required. Ability to provide independent and critical thinking regarding data analysis. Ability to execute quantitative analysis using Crystal Reporting and Excel. Ability to work independently or in team-based situations. Excellent communication skills and professional demeanor. Knowledge of all state and federal regulatory requirements. Ability to multi-task and prioritize effectively. Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings. Don’t miss out on important health care news and updates from Nemours – connect with us on… Facebook (Fan Page) | YouTube | Twitter | Flickr Career, Employment, Jobs, Opening, Occupation, Compensation, Salary, Hospital, Health Care, Healthcare, Medical, Clinical, Pediatrics, Pediatric, Children, Child, Neonatal, Registered Health Information Administrator, Registered Health Information Technician, Technologist, RHIA, RHIT, Tech, Certified Medication Technician, Clerical, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC, AAPC, American Academy of Professional Coders, Finance, Revenue, Financial

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Jacksonville, FL Salary: $60,000-$85,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J137523       About the Opportunity An established managed care company in Jacksonville, FL is actively seeking a self-motivated and dynamic individual for a promising opportunity on their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor establishes and fosters a healthy working relationship between large physician practices, IPAs and the company. Apply today! Company Description Managed Care Company Job Description The Quality Practice Advisor: Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the company can provide support Develops, enhances and maintains provider clinical relationship across product lines Defines gaps in the company's service relationship with providers and facilitate resolution Leads and/or supports collaborative business partnerships Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Required Skills Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following: Certified Coding Specialist (CCS), LPN, LCSW, LMHC, LMSW, LMFT,  LVN, RN, NP, record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 3+ years of directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 1+ year of experience in Managed Care  3 + years of directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 2+ years of experience in directly related HEDIS medical Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Desired Skills Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field

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