Professional Fee Medical Coder

Nemours Children's Health is seeking a remote Professional Fee Abstractor. 

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.  

This is a remote position. 

Essential Functions:

1. 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)
2. Codes a minimum of 60-100 sessions per shift.  The number of lines per session varies, therefore, “Coding Required” sessions are completed daily.
3. Works collaboratively in a team setting with providers, allied health staff, business office staff throughout the enterprise to achieve accurately coded 1500 claims.
4. Analyzes high-risk encounters for accurate charge capture and makes recommendation before transferring to second level review work queues.
5. 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).
6. 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.   
7. 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.
8. Communicates with providers directly for clarification or gaps in documentation prior to submitting the session to assign the code(s) which fit services rendered. 
9. Maintains production and accuracy objectives (i.e. metrics) identified annually.

Qualifications:

• CPC, CCS-P, RHIA, or RHIT required. CRC, CEMC preferred
• 3-5 years coding experience
• Medical Terminology and Anatomy and Physiology preferred

• High School Diploma Required. Associate's preferred

   

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children’s hospitals — Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.

Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.

Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.

Learn more at Nemours.org.