Medical Claim Analyst

Nemours is seeking a Medical Claim Analyst (Full-Time) to join our Nemours Children's Health team in either Wilmington, Delaware, Orlando, Florida, or Jacksonville, Florida. This is a Remote position. The primary function of this position is to: Conduct concurrent charge capture review for accurate change capture and diagnostic and procedural coding. Provide associate education/training on hospital billing and coding within regulatory and compliance guidelines. Identify revenue and charge capture process improvement opportunities. Track all concurrent charge capture review outcomes. Essential Functions Proficiency in hospital coding systems: ICD (International Classification of Diseases), CPT (AMA Procedural Coding), and HCPCS Level II (Healthcare Common Procedural Coding) to independently complete very detailed and complex charge audits. Research authoritative resources to ensure compliance with documentation requirements necessary to support hospital charging practices. Develop and maintain professional relationships with both external and internal customers (i.e., Associates, Clinicians, Directors, and Physicians) to maximize entitled revenue and ensure compliant hospital billing. Provide practical, appropriate, and cost-effective recommendations to Management relating to process improvement and audit findings implications. Consistently document relevant facts and information to support the work performed and the resulting conclusions using spreadsheets and audit findings implications. Prioritize and organize multiple concurrent open audits while still providing quality customer service to financial and clinical departments. Understand financial, operational, and compliance risks of processes when making corrective recommendations. Job Requirements Bachelor's Degree required; however, equivalent work experience may be substituted for the degree. Minimum of 3-4 years coding experience required. Knowledge of hospital billing required. CPC Certification or Certified Outpatient Coding (COC) required. CPMA certification must be obtained within 1 year of hire. Certification in hospital billing from a recognized national program (i.e., AHIMA, AAHAM, etc.) preferred. About the Company

Nemours Children's Hospital is a freestanding, 92-bed, pediatric acute care children's hospital in Orlando, Florida.

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