Medical Coding Specialist (Remote in MN, WI or FL)

About the position The Medical Coding Specialist role is responsible for ensuring that patients are billed correctly for their care and that the business receives proper reimbursement for services provided. They are responsible for the completeness, accuracy, and compliance of all coding assignments prior to claim submission, as well as taking appropriate steps to correct all denied claims. They will support clinicians with ongoing guidance on coding best practices based on established regulatory standards as needed.

Responsibilities

• Conduct prospective review of clinical documentation and reimbursement claims for government programs (Medicare and Medicaid) to ensure documentation, diagnosis and procedural codes accurately reflect and support provider services, in accordance with legal standards and guidelines.
• Interpret medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM, CPT and/or HCPCS codes.
• Document errors and areas for improvement regarding clinical documentation and coding for assigned providers.
• Review claim edits to determine appropriate action. Make necessary changes to claim form to ensure accurate code assignment prior to claim submission.
• Provide technical guidance to providers in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
• Review denied claims to determine appropriate action. Initiate corrections or provide support for appeal, as necessary.
• Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit.
• Collaborate with manager in the development and improvement of work flow processes, for optimum output/efficiency.
• Read bulletins, newsletters, and periodicals and attend workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
• Promote an atmosphere of open communication, team work and staff input in the decision-making process.
• Assist coding supervisor in orienting, training, and mentoring staff.
• Participate in completion of special projects as assigned by coding supervisor.

Requirements

• Current Medical Coding Certification required.
• Strong E/M coding experience preferred.
• Hierarchical Condition Category (HCC) experience preferred.
• Medical billing experience a plus.
• Knowledge of medical terminology and understanding of patient care notes.
• Knowledge of ICD-10-CM, CPT, and HCPCS Coding systems.
• Knowledge of health information and medical record documentation, data integrity and quality.
• Knowledge of Medicare, Medicaid and other third-party payer reimbursement.
• Knowledge of state and federal laws governing billing and coding practices.
• Knowledge of HIPAA regulations.
• Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Proficient in Medicare and CMS guidelines.
• Computer proficiency including ability to navigate electronic medical records system, Google Business Suite, and equipment such as iPhone and iPad.
• Excellent organizational skills with the ability to prioritize tasks and work in a fast-paced environment.
• Strong desire to learn.
• Strong attention to detail, follow-through, and commitment to quality.
• Ability to work independently and proactively to meet company goals and timelines with minimal direction/supervision.
• Ability to positively interact with physicians, providers and staff.
• Strong written and verbal communication skills.
• Skilled in identifying and resolving problems.
• Ability to deal with change and ambiguity.
• Demonstrated compatibility with Bluestone's mission and operating philosophies.
• Demonstrated ability to read, write, speak, and understand the English language.

Benefits

• Health Insurance
• Dental Insurance
• Vision Materials Insurance
• Company paid Life Insurance
• Company paid Short and Long-term Disability
• Health Savings Account (with employer contribution)
• Flexible Spending Account (FSA)
• Retirement plan with 4% matching contributions
• Eight (8) paid holidays for office closures plus two (2) floating holidays per year
• Three weeks (15 Days) Paid Time Off (PTO)
• Mileage reimbursement program for field employees
• Company sponsored cell phone and laptop

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