Inpatient Hospital Coder

About the role

Nemours is seeking an Inpatient Hospital Coder in Orlando, FL responsible for assessing documentation content for services rendered in the hospital and/or professional setting to accurately code principal diagnoses, secondary conditions, procedures, social determinant codes using AHA guidelines, CPT guidelines, payer-specific rules for commercial and/or Medicaid insurance, and drug administration for specified service lines. The role involves assigning codes for multiple encounter/session (single path coding) from hospital to professional lines of business that occur on the same date of service, same place of service, including service lines with same documentation but different code assignments (e.g., radiology) with focus on specific ordering practices. The coder works within Nemours Children's Health, an internationally recognized pediatric health system serving over 1.7 million patient encounters annually across six states, two freestanding children’s hospitals, and a network of primary, urgent, and specialty care practices. Learn more at Nemours.org.

Responsibilities

• Comprehend medical record documentation to accurately assign codes for each active session across multiple specialties.
• Meet minimum production and quality requirements monthly for all procedures/surgeries assigned a CPT code (hospital and professional).
• Apply working knowledge of code sequencing for payer-specific rules, paying attention to detail to avoid rework and waste.
• Understand and apply M.E.A.T. criteria (monitoring, evaluation, assessment, treatment) using ICD-10-CM transaction data set to capture diagnoses.
• Analyze high-risk encounters for accurate charge capture and identify charge gaps prior to encounter completion (e.g., missing charges from anesthesia, surgery) where manual charge capture occurs.
• Incorporate payer-specific trends into day-to-day reviews to reduce “take backs” associated with unclear or unsubstantiated care rendered.
• Facilitate modifications to clinical documentation through concurrent interaction to ensure captured information supports the level of service rendered, with attention to chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Code for hospital and professional sessions routinely as part of daily work.
• Demonstrate proficiency in surgical coding for three or more surgery-based product lines: Cardiac, ENT, General Surgery/GI, Neurosurgery, Plastics, and Urology.
• Utilize hospital information system to retrieve data such as order diagnosis, patient type within a complex filing schema, including non-hospital data (e.g., Media Tab, Office Visits).

Requirements

• Associate's degree preferred.
• Knowledge of Medical Terminology, Anatomy and Physiology.
• One of the following certifications: CCS, RHIT, RHIA; Preferred CRC.
• 3-5 years of experience.