Nemours
Overview
Manager, Hospital Coding and Billing role at Nemours. The Manager is responsible for timely, accurate and compliant charge capture and billing by daily management of key process indicators for revenue, ensuring all encounters are order-based, coded with payer-specific requirements, and contain all charge-related revenue appropriate for each encounter within 5 days. This includes tracing charges back to the point of origin and developing countermeasures to prevent future occurrences, including education at point of workflow failure to reduce denials and missed revenue. Responsibilities
Responsible for the budget associated with coding and billing functions, training of local staff and home office collaborators. Responsible for accurate charge capture of all revenue generated in clinical areas (e.g., Pharmacy, Blood Bank, Bedside Procedures, Emergency Department). Ensure accurate ICD-10-CM, CPT, and ICD-10-PCS coding integrity to assure the assignment is accurate, relevant, and uniform. Attend all charge capture and hospital coding meetings to evaluate documentation and charge gaps in the final claim adjudication process. Analyze high-risk encounters for accurate charge capture of all ordered diagnostic tests with focus on Blood Bank, Laboratory, Cardiac Catheterization, Interventional Radiology, Imaging, and Respiratory. Teach, coach and mentor all hospital coding and billing staff to work collaboratively and decisively, including succession planning with staff. Promote the Single Path Coding concept by educating coders and providers on documentation capture accuracy and the requirement to re-authorize CPT codes when surgery data is updated. Understand billing complexity related to payer forensic audits and incorporate payer-specific trends into day-to-day secondary reviews to reduce takebacks associated with unclear or unsubstantiated care rendered. Review all hospital denials to ensure services rendered are supported with clear documentation, evidence-based logic, and clinical attributes. Maintain monthly DNB goal of
Qualifications
Bachelor’s degree required or equivalent work experience in lieu of degree. One or more certifications required: RHIA, RHIT, CCS, CDIP, or CPC. Epic CDM Certification and/or Epic Resolute Certification preferred. About Us
Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware and Nemours Children’s Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, and other income. As one of the nation’s premier pediatric health systems, we’re on a journey to discover better ways of approaching children’s health. We focus on prevention as well as cures and work with the community to make every child’s world a place to thrive. This journey extends beyond clinical treatment to research, advocacy, education, and prevention, leading to healthier generations of children. Inclusion and belonging guide our growth and strategy. We seek individuals who are passionate about providing culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All associates are expected to embed these philosophies in their day-to-day work with colleagues, patients, and families. To learn more, visit www.nemours.org.
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Manager, Hospital Coding and Billing role at Nemours. The Manager is responsible for timely, accurate and compliant charge capture and billing by daily management of key process indicators for revenue, ensuring all encounters are order-based, coded with payer-specific requirements, and contain all charge-related revenue appropriate for each encounter within 5 days. This includes tracing charges back to the point of origin and developing countermeasures to prevent future occurrences, including education at point of workflow failure to reduce denials and missed revenue. Responsibilities
Responsible for the budget associated with coding and billing functions, training of local staff and home office collaborators. Responsible for accurate charge capture of all revenue generated in clinical areas (e.g., Pharmacy, Blood Bank, Bedside Procedures, Emergency Department). Ensure accurate ICD-10-CM, CPT, and ICD-10-PCS coding integrity to assure the assignment is accurate, relevant, and uniform. Attend all charge capture and hospital coding meetings to evaluate documentation and charge gaps in the final claim adjudication process. Analyze high-risk encounters for accurate charge capture of all ordered diagnostic tests with focus on Blood Bank, Laboratory, Cardiac Catheterization, Interventional Radiology, Imaging, and Respiratory. Teach, coach and mentor all hospital coding and billing staff to work collaboratively and decisively, including succession planning with staff. Promote the Single Path Coding concept by educating coders and providers on documentation capture accuracy and the requirement to re-authorize CPT codes when surgery data is updated. Understand billing complexity related to payer forensic audits and incorporate payer-specific trends into day-to-day secondary reviews to reduce takebacks associated with unclear or unsubstantiated care rendered. Review all hospital denials to ensure services rendered are supported with clear documentation, evidence-based logic, and clinical attributes. Maintain monthly DNB goal of
Qualifications
Bachelor’s degree required or equivalent work experience in lieu of degree. One or more certifications required: RHIA, RHIT, CCS, CDIP, or CPC. Epic CDM Certification and/or Epic Resolute Certification preferred. About Us
Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware and Nemours Children’s Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, and other income. As one of the nation’s premier pediatric health systems, we’re on a journey to discover better ways of approaching children’s health. We focus on prevention as well as cures and work with the community to make every child’s world a place to thrive. This journey extends beyond clinical treatment to research, advocacy, education, and prevention, leading to healthier generations of children. Inclusion and belonging guide our growth and strategy. We seek individuals who are passionate about providing culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All associates are expected to embed these philosophies in their day-to-day work with colleagues, patients, and families. To learn more, visit www.nemours.org.
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