3 coder jobs found

Nemours is seeking a Sr. CDM Specialist  in Orlando, FL This position is responsible for: assistance in maintenance of Charge Description Master (CDM) within Nemours hospital revenue producing departments. Works with the CDM/HB Manager to ensure an accurate CDM and Coding process resulting in clean and compliant claims. Acts as liaison and problem solver for CDM issues with Administration, insurance companies, charge capture departments, Health Information Management, Utilization Management, Recovery Auditors, Managed Care, Corporate Compliances, and Central billing Office (CBO).  Responsibilities: Responsible for the coordination of ongoing CDM consistency within revenue producing departments. Includes maintaining accurate descriptions, coding, in-activations, and revenue code assignments.      Demonstrate and incorporate a working knowledge of the hospital's billing and coding software applications as related to coding and billing of...

CPC Expertise in medical record review to abstract information required to support accurate coding. Ability to identify documentation deficiencies and properly query providers for proper code capture. Expertise in assigning accurate CPT, HCPCS Level II, and ICD-10-CM medical codes for diagnoses and procedures. Proficiency across a wide range of services, including evaluation and management, anesthesia, surgery, radiology, pathology, and medicine. A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CPC to better handle issues such as medical necessity, claims denials, bundling issues, and charge capture. CPB Proven knowledge of how to submit claims compliant with government regulations and private payer policies. Ability to follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. In-depth knowledge of...

The Certified Professional Medical Auditor is responsible for performing comprehensive audits of medical records, coding, and billing to ensure accuracy, compliance with federal and state regulations, and alignment with payer policies. This role helps protect the organization from financial risk, supports accurate reimbursement, and promotes high standards of documentation and clinical integrity. Key Responsibilities Perform prospective and retrospective audits of medical records, coding, and billing across assigned service lines (e.g., outpatient, inpatient, behavioral health, SUD/MH, lab). Verify that documentation supports ICD‑10‑CM, CPT, and HCPCS coding; identify under‑coding, over‑coding, unbundling, and other compliance risks. Review claims for adherence to Medicare/Medicaid, commercial payer, and regulatory guidelines; ensure compliance with NCCI edits and payer‑specific policies. Prepare clear, detailed audit reports summarizing findings,...