Professional Fee Abstractor (Finance)
Nemours is seeking a Professional Fee Abstractor , Full-Time, to join our Nemours Children's Health team.
Assesses each professional session (i.e. claim) for all documented conditions and application of M.E.A.T. criteria (i.e. 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. (i.e. 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 (i.e. metrics) identified annually.
Job Requirements
- High School Diploma required. Associate's Degree preferred.
- Minimum of three (3) to five (5) years experience required.
- One of the following is required: CCS-P, CPC, RHIA, OR RHIT
- CRC, CEMC preferred.
- RCC or other qualifying specialty certification
- Knowledge of all state and federal regulatory requirements associated with billing and coding.
