As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
Nemours is seeking a Hospital Billing Partner (FULL-TIME), to join our Nemours Children's Hospital team in Orlando, Florida
Located in Orlando, Fla., Nemours Children’s Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the area’s only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children’s Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region.
The associate is responsible for timely, accurate and compliant charge capture and billing by daily management of key process indicators for revenue which include assuring 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 the charge back to the point of origin (i.e. system generated charge; flow sheet generated charge; associate generate charge) and developing countermeasure(s) to prevent future occurrences, which includes education at point of work flow failure to reduce denials and missed revenue.
Responsible for budget associated with billing functions, training of local staff and home office collaborators.
Attends all charge capture related meetings (e.g. hospital billing, hospital denials) to evaluate documentation and charge gaps in final claim adjudication process.
Analyzes 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.
Teaches, coaches and mentors all billing/Charge capture staff to work collaboratively, accurately and decisively including succession plan rounding with staff.
Works collaboratively with Compliance, and CBO contributors for any audit reviews upon request.
Understand complexity of billing requirements and incorporates payer specific trends into day-to-day secondary reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered.
Reviews all hospital denials to ascertain whether or not services rendered are supported with clear documentation, evidence based logic, and clinical concomitant attributes.
Bachelor's Degree required.
Minimum of five (5) + years experience required.
Knowledge of all state and federal regulatory requirements associated with billing, coding and clinical documentation improvement.
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is a pediatric health system of hospitals and specialty clinics serving children and families throughout the Delaware Valley and Florida. Our dedicated professionals integrate medical care, research, health education, and prevention to help improve the lives of children every day.