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.
This position is responsible for: performing assigned duties of a hospital billing specialist at AIDHC. Ensures “front end” hospital billing claim is complete and accurate according to regulatory guidelines. Works with insurance companies, charge capture departments, CDM Manager, recovery Auditors, coding/billing integrity, and central billing office.
Essential Functions –
1. Reviews, monitors and completes hospital claims for all elements of the UBO4 billing form according to CMS and specific payor guidelines.
2. Reviews daily DNB (Discharged Not Final Billed) accounts within assigned workqueue(s).
3. Works closely with CDM Manager and Central Billing Office to ensure all related charges errors are corrected and reported for needed process improvement.
4. Performs specialty billing for Medicare End Stage Renal Disease patients.
5. Works closely with Transport department and completes charge capture for Nemours Transport services.
6. Provides service to internal and external customers as a member of the hosptial billing department.
7. Assists Recovery Audit staff with all claim submission inquiries and reimbursement explanation of benefit data.
8. Conducts research related to hospital billing issues using various types of information media: internet, payor intranet, payor newsletters and/or manuals.
9. Provides support to scheduling and registration departments with patient coverage, eligibility and authorizations.
10. Works assigned claim edit workqueues correcting all errors and warnings to ensure first-time claim accuracy.
1. Maintains exceptional billing knowledge through related continuing education.
2. Communicates effectively with all revenue cycle staff within Nemours.
3. Assists with special projects as needed.
4. Participates in hospital billing department meetings.
High School Diploma
1-3 years of job related experience
Preferred cortication: CRCS-I certification or able to get it within 12 months
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 committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.