Medical Coding Specialist

2 weeks ago

Stillwater, United States Bluestone Physician Services Full time
Job DescriptionJob Description

Bluestone Physician Services’ unique, robust model of care goes beyond primary care services. Our model is tailored to patients living with multiple chronic conditions and disabilities. Bluestone recognizes that patients need a customized approach to care that is preventative, proactive and includes all members of the care team. Medical providers, nurses and social workers collaborate with patients’ other healthcare providers and families.

Our Care Model delivers customized care that is preventive, proactive, and includes all members of the care team, patients and their families.  Our patients experience 21% less ER visits, 36% less hospitalization and 41% less hospital re-admissions compared to patients with similar conditions and complexities.

Bluestone has locations in Minnesota, Wisconsin, Florida and uses a mobile clinic approach to provide care to patients within Assisted Living, Memory Care, and Group Home Facilities.

At Bluestone, our employees are our most valuable asset. We know our success is only possible through the hard work and dedication of each of our employees. 

Bluestone has been named to the Star Tribune's Top Workplace list every year since 2013 Bluestone also achieved Top Workplace USA 2021-2024 

Position Overview:

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.

Candidates for this remote role must be located in one of Bluestone Markets (Minnesota, Wisconsin or Florida).

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

Qualifications:

Education/Certification/Experience

  • Current Medical Coding Certification required
  • Strong E/M coding experience preferred 
  • Hierarchical Condition Category (HCC) experience preferred
  • Medical billing experience a plus

Knowledge/Skills/Abilities

  • Knowledge of: 
    • Medical terminology and understanding of patient care notes 
    • ICD-10-CM, CPT, and HCPCS Coding systems 
    • Health information and medical record documentation, data integrity and quality 
    • Medicare, Medicaid and other third-party payer reimbursement 
    • State and Federal laws governing billing and coding practices 
    • HIPAA regulations
  • Maintains an expert level of knowledge of coding related guidelines and practices 
  • 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 
  • 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

Bluestone 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 paid holidays for office closures plus two floating holidays
  • Three weeks (15 Days) Paid Time Off (PTO)
  • Company sponsored laptop and computer accessories
  • Regular business hours



 

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