Medical Coding Specialist

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
Position Overview

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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

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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

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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 Bluestones mission and operating philosophies
Demonstrated ability to read, write, speak, and understand the English language
Bluestone Benefits

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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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