Center for Health Care Strategies

Medical Billing and Coding

• 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)

Outpatient Surgery Coder

Abstractor

• Analyze and classify documents within the document management system.
• Index documents into the patient’s electronic medical record (EMR) as digital formats, for ease of storage, retrieval, and use.
• Maintain a 99% accuracy rate and 95% productivity rate.
• Create encounters in the EMR system as per policy and procedure as needed to consistently locate patient documentation.
• Demonstrate a working knowledge of the HIM policies and reliable methods governing the verification process.
• Validating the authenticity of legal documents.
• Utilizing advanced technology to eliminate printing and redundancy of documents.
• Apply critical thinking skills, exhibit strong independent judgment, and research skills. Able to assess complex problems, overcome challenges, and adapt to changes.
• Additional miscellaneous duties and responsibilities, as may be assigned from time to time by employee’s supervisor.

HIM Abstractor I – Temporary

Pharmacist

• Actively participates in system planning, design, building, validation, implementation, enhancement, and maintenance processes for the electronic health record systems (EHR), and adjunct systems.
• Collaborates with department, enterprise IT associates, and hospital clinicians in the design, implementation and updating of clinical pathways, EHR build for primary medication orders, and order sets, protocols, charge master, and rules.
• Participates in Health Informatics testing for implementation of system upgrades, enhancements and patches while minimizing impact on department workflow, quality and specified regulatory and business functions.
• Maintains current medication formulary within the pharmacy and Physician Order Entry EHR systems as well as medication dosing resources, quality, safety, finance (charge master) systems, and infusion pump libraries.
• Responsible for build, maintenance and testing of all pharmacy electronic and data systems, infusion pump medication libraries and associated technologies in conjunction with clinical and operations pharmacy associates and leaders.
• Serves as a liaison for billing related questions and claim investigation as well as assures appropriate charging as relates to medications ordered utilizing the EHR systems.
• Coordinates training and education for departmental associates regarding modifications and enhancements to the clinical order management in the EHR systems, electronic medication resources, automated dispensing devices, and infusion pump libraries.
• Precepts Post-graduate Pharmacy Residents as part of dedicated Clinical Informatics rotation.

Clinical Pharmacy Specialist – Informatics

Manager

• Provides operational leadership for quality improvement (QI), patient safety, and performance improvement activities within the Department of Surgery
• Leads and executes the administrative, strategic, and clinical direction of the Surgical Quality and Patient Safety Program
• Oversees the day-to-day management of surgical quality infrastructure
• Ensures alignment with enterprise quality and safety priorities
• Partners with surgical, anesthesia, nursing, and operational leaders
• Translates strategic priorities into executable improvement initiatives
• Supervises surgical Quality Improvement Specialists and Safety Quality Specialists
• Builds quality improvement capability within the Department of Surgery

Manager, Quality Improvement – Surgical Services

Procurement

• Segment, unpack and rationalize the external spend across the enterprise: a. Conduct historical spend data analysis. b. Identify and aggregate our categories of spend to determine our leverage opportunities. c. Present findings to Administrative Director and obtain support to drive projects that align to Nemours strategies
• Conduct due diligence to: a. Gain insight into our internal demand. b. Identify, analyze and evaluate our supply chain. c. Identify key stakeholders. d. Develop a more formalized supplier management program for our primary suppliers. e. Quantify the total costs for the key services that we purchase.
• Focus on strategic cost reduction to formulate and implement actionable projects that will create value
• Manages the contracting function as it relates to the procurement of goods and services
• Responsible for working in a collaborative fashion with Corporate Legal in order to insure that contract language is in the best interest of Nemours
• Responsible for collaborating with end users to insure that quality and patient care issues are at the forefront of all contract activities.
• Facilitates toe coordination of multidisciplinary discussions to ensure that IT, Facilities and all other appropriate areas are involved and have the opportunity to provide input to contract language where appropriate
• Uses Lean and / or Continuous Improvement philosophies to guide activities
• Conducts business with consideration to Premier, our Group Purchasing Organization

Contract Sourcing Specialist

Research Scientist

• Plan and oversee a wide range of projects in basic/translational research
• Prepare and submit grant applications to secure external funding support
• Publish high impact manuscripts in the field of neuroscience
• Supervise the maintenance, safety, and running of the laboratory
• Supervise and train laboratory technicians, students, and postdoctoral fellows

Research Scientist – Cancer Innovation

Analyst

• Providing direct technical and consultative support in the administration of the organization's staff compensation policies and practices.
• Performs standard compensation surveys and research studies, conducts compensation analyses, and maintains the job description and compensation databases.
• Primarily responsible for managing the day-to-day compensation activities and provides support and advice to HR Business Partner's regarding interpretation of policies, guidelines, and procedures.
• Supports Compensation Manager in project management activities.
• Research and analyze competitive compensation practices in the labor supply areas and contributes to established compensation surveys and/or develops and implements custom surveys as appropriate.
• Conducts internal and external compensation analyses and, under the direction of the Compensation Manager, provides HR Business Partners and management with salary determination recommendations.
• Performs specialized research studies on a range of compensation topics, as specifically assigned, including analyzing data and preparation of summary reports.
• Assists and collaborates, as appropriate, in the planning, coordination, facilitation, administration, and reporting of the annual salary review program.
• Maintains and updates compensation databases and consults with HRIS regarding problems with programming and data integrity issues.
• Works with payroll personnel to implement new pay structures and helps resolve payroll issues, where appropriate.
• Interprets and may assist in development of enterprise-wide compensation policies and practices.
• Conducts job analyses to ensure compliance with Federal and state wage and hour regulations.

Compensation Analyst

Operations

• Manage compensation programs and provide strategic guidance for competitive pay practices.
• Oversee merit and performance management cycles for accuracy and timely execution.
• Identify opportunities to streamline compensation processes and develop standardized tools.
• Provide mentorship to compensation analysts and lead initiatives for data integrity.

Manager, Compensation Operations – Total Rewards

Counselor

• Responsible for providing current and accurate information regarding genetic testing, informed consent, results interpretation, and recommendations
• Works collaboratively with other genetics providers during outpatient and inpatient genetics visits.
• Completes chart preparation and obtains appropriate history and consent, providing genetic counseling and coordination diagnostic testing and follow up for individuals referred for clinical genetics assessment.
• Provides appropriate risk assessment, genetic counseling, and resource identification based on family history and genetic testing/evaluation and coordinates necessary evaluations, diagnostic tests, and referrals to other specialists.
• Follow up with patients as necessary regarding disclosure of test results, recommendations, resources and psychosocial support.
• Communicate with appropriate internal and external providers for purposes of consultation, referral, and coordination of patient care.
• Assure complete and accurate documentation related to genetic information and genetic counseling in the medical record.
• Maintain up to date knowledge regarding clinical genetics by attending educational and scientific conferences and participation in continuing education regularly.
• Supervision of genetic counseling master program and other rotating students.

Medical Genetics/Neurology Genetic Counselor

Vice President

• Provide strategic oversight of all revenue cycle functions including: Health Information Management, Patient Financial Services (Central Business Office), Revenue Integrity, Coding for Hospital and Physician Practices
• Lead a multi-state, integrated revenue cycle model across Delaware, Florida, and affiliated sites of care
• Establish a high-performing, standardized operating model with clear accountability and KPIs
• Drive improvements in key performance metrics: Net patient revenue yield, Days in Accounts Receivable (A/R), Cash collections, Denial rates and overturn success, Cost to collect, Discharge Not Final Billed
• Lead enterprise-wide initiatives to reduce revenue leakage and improve margin performance
• Partner with finance leadership on forecasting, budgeting, and long-range financial planning
• Oversight of System Revenue Cycle Committee
• Optimize revenue cycle processes in a high Medicaid payer mix environment (~50%)
• Partner with payer strategy and managed care teams to improve reimbursement accuracy, reduce administrative burden, strengthen payer-provider collaboration
• Ensure readiness for evolving reimbursement models including value-based care and risk arrangements
• Lead optimization and continuous improvement of EPIC revenue cycle systems
• Drive automation, AI, and analytics capabilities across the revenue cycle: Predictive denials management, Intelligent work queues, Real-time eligibility and authorization tools
• Advance digital patient financial experience: Transparent pricing, Digital billing and payment platforms
• Ensure a frictionless, compassionate financial journey for patients and families
• Align revenue cycle processes with Nemours’ mission of family-centered care
• Reduce financial barriers to care while maintaining strong financial stewardship
• Ensure compliance with all federal and state regulations including: CMS billing requirements, Medicaid policies, No Surprises Act and price transparency
• Maintain strong internal controls and audit readiness
• Partner with compliance and legal teams on risk mitigation
• Lead, mentor, and develop a large, diverse revenue cycle workforce
• Build a culture of accountability and performance excellence, innovation and continuous improvement, collaboration across clinical and administrative teams
• Develop future leaders within the revenue cycle organization.
• Key Partnerships: Chief Financial Officer, Chief Operating Officer, Market Presidents, Market CFOs, Chief Information Officer / Digital & IT teams, Payer Strategy & Managed Care, Clinical leadership across service lines, External vendors and revenue cycle partners.

VP, Revenue Cycle

Data Analyst

• Partner with clinical, operational, and enterprise stakeholders to identify benchmarks, interpret performance, and guide improvement efforts.
• Analyze and translate complex data to support strategic and organizational decision‑making.
• Build and maintain dashboards, reports, and analytic tools across EPIC, Qlik Sense, and Excel.
• Maintain timely external state data integration (AHCA, PHC4, etc.).
• Ensure data integrity through testing, documentation, and quality assurance activities.
• Serve as a data standards liaison and provide training to stakeholders.
• Support enterprise strategy and market positioning with internal and external environmental analyses.
• Deliver ad‑hoc analytics to meet evolving organizational needs.
• Support patient care and operational needs by assisting with data analyses and generating accurate reports using Microsoft Excel and other analytic tools; prior Qlik Sense, Intermediate Excel and EPIC knowledge preferred.
• Use geospatial analysis tools (ESRI ArcGIS) to create clear, compelling visualizations for leadership presentations.
• Help educate and inform stakeholders by explaining report contents, metric definitions, and data updates to leaders and data owners.
• Support project reporting activities by compiling weekly and monthly updates, documenting progress, identifying issues, and communicating follow‑up needs to project teams.
• Build effective working relationships with colleagues across clinical, operational, and enterprise areas to understand data needs and ensure accurate information flow.
• Maintain data accuracy and integrity by conducting routine validation, testing, and documentation of analysis and reporting outputs.
• Communicate clearly and professionally to translate data findings into simple, understandable insights for various audiences.

Strategy & Data Insights Analyst II

Therapist

• Day to day activities will be within the SBHC team, and the therapist will also be linked to the Division of Behavioral Health at Nemours.
• Teaching, training, and mentoring are core values in our division.
• Committed to expanding workforce diversity.
• Practice continuous learning through educational opportunities that guide health equity approach.
• Additional miscellaneous duties as assigned by supervisor.

Licensed Behavioral Health Therapist – School-Based

Compliance

• Support Research Compliance and Integrity activities by coordinating documentation, tracking regulatory deliverables, and assisting research teams with compliance-related administrative requirements in alignment with Office of Research Compliance guidance.
• Assist with financial disclosures and serve as a liaison for the office of research integrity for by facilitating communication, meetings for the committee on research integrity, and supporting responses for inquiries.
• Assist with research risk mitigation efforts by identifying potential compliance gaps (e.g., lapsed approvals, training deficiencies, documentation inconsistencies) and escalating concerns to appropriate leadership or compliance offices per institutional procedures.
• Provide administrative management support for the office for research integrity and research compliance, including coordination of activities across all relevant Nemours sites and prepare quarterly and annual reports as required by Nemours, or other regulatory requirements.

Program Coordinator, Research Compliance and Integrity

QA Engineer

• Ensure the Sponsor, Investigator, and study team adhere to current FDA regulations, applicable ICH/GCP guidelines, local policies and standard operating procedures.
• Assist in the development and writing of clinical trial monitoring plans based on risk based monitoring.
• Adhere to monitoring plans; e.g. monitoring visit type, frequency, and required critical monitoring activities by utilizing monitoring tracking forms and other monitoring related tools and templates.
• Monitor clinical trial progress through a combination of data review and on site/remote monitoring visits.
• Verify that trial data is consistent with patient clinical notes and other source documentation (source data verification/review).
• Independently coordinate ongoing and upcoming monitoring assignments.
• Meet expected timelines for completion of monitoring activities and submission of written monitoring reports.
• Provide recommendations and guidance to study specific monitoring teams and assist in audit readiness and preparation.
• Provides training programs for clinical research associates developed by the Quality Assurance and Research Program.
• Participates in education of new team members as well as ongoing education of teams based on gaps identified through internal audits, sponsor monitoring visits, changes in regulations, departmental/corporate policies and other factors as determined by department leadership.
• Must be willing to travel up to 30% of the time as needed.
• Must be able to maintain strict confidentiality.

Quality Assurance and Research Education Coordinator

Director

• Provide strategic leadership and direction to the Data Engineering and Data Insights teams, fostering a culture of innovation and collaboration.
• Collaborate with business units to identify data needs, prioritize projects, and align analytics initiatives with organizational goals.
• Design, implement, and manage robust data pipelines, ensuring high-quality, reliable, and scalable data solutions across Qlik, Microsoft Fabric, Power BI, and SQL environments.
• Lead teams in the development, deployment, and maintenance of reporting and analytics solutions, ensuring compliance with data governance, quality and security standards.
• Develop and oversee reporting frameworks that deliver meaningful business insights to stakeholders, enabling data-driven decision making.
• Mentor and develop team members, promoting continuous learning and professional growth within the analytics function.
• Drive continuous improvement initiatives, leveraging data analytics to optimize workflows, improve operational efficiencies and enhance patient care outcomes.
• Oversee vendor relationships, contract negotiations, and system upgrades for analytics platforms.