Professional Fee Abstractor

Nemours is seeking a Professional Fee Abstractor (Coder), Full-Time, to join our Nemours Children's Health team.

Assesses each professional session ( claim) for all documented conditions and application of criteria ( 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. ( 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 ( metrics) identified annually.

Job Requirements