Center for Health Care Strategies

Director

• Develop and execute a comprehensive, data driven outreach and provider relations strategy that supports hospital growth priorities, specialty service line development, and access goals.
• Establish clear objectives, performance metrics, and analytics to measure outreach effectiveness, referral trends, and relationship impact.
• Align outreach strategies with organizational strategic plans, market dynamics, and evolving pediatric care needs.
• Provide direct oversight, coaching, and performance management for Physician Liaisons.
• Ensure Physician Liaisons effectively plan, coordinate, and execute outreach initiatives focused on community physicians, referring partners, and potential new referral sources.
• Standardize outreach processes, messaging, and reporting to ensure consistency, quality, and regulatory compliance.
• Provide dotted-line leadership to Outreach Coordinators supporting service lines.
• Collaborate with service line leaders to align outreach activities with specialty-specific goals while ensuring consistency with enterprise outreach standards.
• Serve as a senior leader and ambassador to community physicians, advanced practice providers, health systems, and other referral sources.
• Cultivate trusted, long-term relationships by understanding referral patterns, clinical needs, and access challenges.
• Use data to objectively understand and drive referral volumes, market share, physician engagement metrics, and outreach ROI.
• Prepare and present executive-level reports and recommendations for senior leadership.

Senior Director, Outreach & Provider Relations

Financial Planning and Analysis

• Convey courtesy, dignity, respect and a positive attitude through words and actions
• Demonstrate effective communication and respect by using active listening skills
• Utilize daily work queues, reports and schedules to assist underinsured/uninsured patients
• Interview patients/families to obtain comprehensive financial information
• Respond timely and appropriately to all internal referral requests and external customer calls
• Collaborate with Authorization and Patient Cost Estimate teams
• Ensure payment plans, discounts, charity care are accurately assigned to accounts
• Coordinate with insurance carriers to verify eligibility and determine healthcare benefits

Financial Family Advocate II

General

• Promptly answers incoming calls to schedule appointment for patients; makes outbound calls when follow-up is needed.
• Provide a smooth transition for all internal and external customers by utilizing excellent customer service skills and effective communication.
• Ensures efficient processing and documentation of all information required for insurance verification, registration and billing in the Electronic Medical Record (EMR) system.
• Schedule patient appointment according to established division guidelines and communicate updates and barriers in a timely manner.
• Ensure urgent diagnosis and appointments are handled with priority and escalation processes are utilized when necessary.
• Verify insurance eligibility and authorizations utilizing the available resource tools.
• Utilize the Managed Care Manual to verify participating insurances and their requirements.
• Inform the caller of their financial responsibility that is due at the time of service/offer to collect in advance at the time of scheduling and ensure accurate daily cash reconciliation.
• Adhere to the authorization process by informing the caller that an authorization is needed (if applicable) at the time the appointment is made.
• Refer patients to the Financial Advocates if financial assistance is needed.
• Educate the callers on the preparation for the appointment or requirements needed to ensure a productive visit.
• Accurately notate the patient’s accounts to communicate pertinent information to clinic, registration, authorization, family financial, and billing departments.
• Request medical records when necessary.
• Review work queues on a daily basis, make corrections and/or escalate to leadership if necessary.
• Respond to and complete staff message.
• Provide support for Cancelled Clinic requests.
• Review and take the necessary action to ensure patient scheduled appointments are accurate.
• Always offer specific directions to the clinic and location that they will be seen.
• Stay up to date of appointment scheduling changes and insurance requirements.
• Interact with coworkers and clinic personnel in a professional manner.
• Communicates effectively with patients, physicians and/or other departments regarding delays or any issues relating to patient appointments.
• Consistently achieve team metric standards and expectations.
• Maintains strict confidentiality at all times.
• Positively support mission, vision and values of Nemours.
• Brings forth any compliance/ethic issues and recommendations for operational improvement.
• Ensures successful adherence to policies, procedures and changes to the organization
• Other duties as assigned.

Access Center Specialist II

Medical Billing and Coding

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

Counselor

• Work closely with providers and genetic counselors to facilitate provision of genetic testing services.
• Communicate with hospital authorization group, providers, and insurance companies to obtain medical insurance coverage for genetic testing and provide medical information from providers for appeal processes, etc.
• Discuss insurance coverage information with families and coordinate genetic counseling consent appointments and sample collection.
• Contact genetic testing laboratories and pathology departments regarding sample availability, sample requirements, test costs, and other relevant information.
• Work with genetic counselors and other clinical providers to draft letters of medical necessity and result letters for genetic testing.
• Track results of genetic testing to ensure timely delivery of results to team and patients.
• Complete Genetic Testing requisition forms
• Obtain medical records, perform chart review
• Other tasks as needed

Genetics Counselor Assistant

Manager

• Leads the ongoing operations of the Epic Scheduling team.
• Maintains a strong understanding of organizational access goals, operational workflows, and clinical scheduling needs.
• Leads day-to-day operations of the Epic Scheduling team, balancing multiple priorities across support, enhancements, and strategic initiatives.
• Translates strategic access and operational priorities into system capabilities.
• Serves as a technical subject matter expert in Epic scheduling applications.
• Manages team capacity and resource allocation across a high volume of operational and strategic work.
• Coordinates and executes work across cross-functional teams, providing technical leadership on Epic scheduling design, configuration, and integrations.

IS Business Application Manager

Analyst

• Provide direct support to end users in the efficient and accurate utilization of IS Imaging Informatics applications and the electronic medical record as it relates to imaging.
• Participate in building, testing and validating of new functionality and engaging in custom configuration activities.
• Perform in-depth analyses of workflows, data collection, report details and other technical issues associated with clinical applications.
• Recognize opportunities for process improvement and optimization activities designed to create more knowledgeable end users.
• Act as a change agent, educator and resource in advancing the strategic mission of Nemours, while advancing knowledge and avoidance of data and systems integrity risks.

Imaging Informatics Associate Analyst – Cardiology

Software Engineer

• Develop and maintain data solutions using Microsoft Fabric, including Lakehouse, SQL Analytics Endpoint, Spark, and OneLake.
• Build and enhance data pipelines for ingestion, transformation, and curation of enterprise data.
• Contribute to CI/CD implementation for Fabric assets using GitHub, including notebooks, SQL scripts, and deployment workflows.
• Support modernization efforts for workloads currently dependent on the on‑prem EDW.
• Assist in addressing technical debt resulting from the Clarity Oracle to SQL Server migration.
• Collaborate with senior engineers and architects to follow established data engineering standards and best practices.
• Support testing, validation, and operational monitoring of Fabric workloads.
• Participate in production support and issue resolution as needed to ensure platform reliability.

Enterprise Intelligence Developer

System Administrator

• Daily management and oversight of cloud applications including end-user support, environment monitoring, user management, and compliance.
• Provisions and de-provision cloud accounts for internal customers and vendors.
• Deploys, manages, and operates cloud environments in coordination with cloud service providers.
• Act as project lead around further software and platform defined services and offerings.
• Rapidly responds to issues, facilitates follow-up and resolution.
• Collaborates with cloud service providers to develop, refine, and ensure compliance with business continuity and disaster recovery plans.
• Performs vulnerability management for resources in all cloud environments.
• Monitors system availability and performs ongoing performance tuning and optimization.
• Maintains documentation of cloud resources, build checklists, scripts, diagrams, etc.
• Participates in design, implementation, and management of workflow automation initiatives.

Cloud Systems Administrator

Solutions Engineer

• Assists primary engineer with projects, which may include assisting project manager in the coordination of project plan activities; ensuring timely and effective communication between all members of the project team regarding daily status and issues; and preparing go live and sign off documents and processes.
• Provides daily support for existing integration solutions, including modifying, testing, validating, and documenting system changes. Adheres to normal change control processes for these activities.
• Day to day system administration of various integration tools including performance tuning, system monitoring, problem investigation, and application upgrades.
• Helps to identify process and procedural issues, may suggest potential solutions, and engages teammates or other teams as required.
• Provides on-call off hours support daily or on weekends as required to support the applications.

Associate Integration Solutions Engineer

• Following departmental policies to collect data for the verification and evaluation of medical staff credentials.
• Obtain primary source verification of professional credentials for applicants to the medical staff and practices in accordance with departmental policy.
• Collect data and prepare medical staff reappointment files for presentations to various committees and physicians.
• Maintain the confidentiality of highly sensitive practitioner-specific information.
• Maintain accurate, complete and timely information in the credentials software system.
• Assist in the maintenance of systems to track expiring documents.
• Assist in the preparation and updating of all required documents.
• Use discretion in preparing reports and releasing such reports containing highly sensitive practitioner-specific information.
• Respond to queries regarding status of pending applications.
• Other duties as assigned.

Credentials Specialist

Referral Coordinator

• Facilitate access to care. This role is a duel role with half time with Diagnostic Referral Service and half time with Transplant team. This includes scheduling of patients at all Nemours sites of service. Maximize template utilization. Manage the wait list and referral work queue to ensure it is at or below established metrics.
• Manage divisional templates to ensure ease of patient access, provider effectiveness and efficient clinic flow.
• Provide daily administrative support to assigned members of the clinical team; including the Division Chief. Assist in the coordination and support of enterprise/departmental/divisional projects and initiative which further the clinical, educational and research missions of the Department of Pediatrics and its Divisions.

Medical Practice Coordinator – Diagnostic Referral Service

• Join current overnight group as a 100% remote nighthawk with a 1 week on and 2 weeks off model
• Work collaboratively with another radiologist overnight
• Contribute to full pediatric imaging services at various Nemours facilities
• Participate in educational opportunities with Pediatric Radiology and Pediatric Neuroradiology fellowships

Pediatric Radiologist, Overnight

Abstractor

• 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.

Fee Abstractor

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with unclear, or unsubstantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)