Join our team as a Remote Outpatient Surgical and Observation Coder! Role responsibilities include assessing documentation for each service rendered in the hospital’s place of service, in order to accurately code principal diagnoses (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. This includes excellent working knowledge of revenue charge capture and the impact to hospital billing (soft vs. hard coded charges), working knowledge of revenue codes, relevant grouper function and financial impact, assessment and entry of surgical charges (supplies, implants), and pharmacy charges (contrast, patient supplied, etc).

This is a remote position. Applicants must reside in one of the following states: Alabama, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

Responsibilities:

Comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
Meet minimum requirements for production and quality monthly.
Understand code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment.
Apply M.E.A.T. criteria (monitoring, evaluation, assessment, treatment) using ICD-10-CM transaction data to capture diagnoses.
Analyze high-risk encounters for accurate or missing charges gaps prior to encounter completion (e.g., missing anesthesia or surgery charges).
Understand billing complexity and incorporate payer-specific trends to reduce take backs associated with unclear or unsubstantiated care.
Maintain excellent coding knowledge of ICD-10-CM, CPT-4, and modifier application, with certifications (CCS, CPC, RHIT, or RHIA) and apply ICD-10-CM Coding Guidelines for inpatient and outpatient encounters.
Facilitate clinical documentation queries to ensure captured information supports the level of service rendered, including chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
Demonstrate excellent working knowledge of hospital information systems to retrieve specific data from complex filing schemas including non-hospital data.

Qualifications:

Minimum education: Associate's degree.
Knowledge of Medical Terminology, Anatomy, and Physiology.
Certification required: one of CPC, CCS, RHIT, RHIA, or COC.

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters annually, delivering care across multiple states with children's hospitals, primary, urgent, and specialty care practices, and hospital partnerships. It is committed to improving children's health through clinical care, research, education, advocacy, and prevention, with a focus on culturally relevant care and reducing health disparities.