at Spectrum Healthcare Partners in Portland, Maine, United States
COMPANY OVERVIEWSpectrum is Maine’s largest multi-specialty, physician owned and directed professional organization and is comprised of over 200 physicians practicing in the areas of anesthesiology, orthopaedics, pain management, pathology, radiation oncology, radiology, and vascular & interventional services. Spectrum provides services at many of Maine’s hospitals throughout the state and in eastern New Hampshire. POSITION SUMMARY Reviews written documentation to verify and assign CPT, HCPC, ICD10 codes for billing, utilizing correct coding practices for visit levels, modifiers, bundling, payer and diagnosis code rules. Provides administrative support and assistance to the billing staff. Performs charge entry and medical coding tasks for the practice, clinic and when applicable Ambulatory Surgery Center and Physical/Occupational Therapy Clinics/Centers. Ensures accurate, compliant and complete medical coding to support services performed. HOURS: Flexible hours, as needed; Remote once trained ESSENTIAL FUNCTIONS
+ Accurately assign CPT, ICD-10 CM and PCS, and HCPC codes to professional and facility charges (when applicable) for surgeries, office-based services, professional and facility services and durable medical equipment.
+ Assists in assignment of CPT, HCPC and ICD 10 codes for pre-authorization of services.
+ Performs daily/monthly charge and payment reconciliation to ensure all charges and payments have been captured and entered into the Practice Management system
+ Collaborates with ASC surgical staff to ensure accurate assignment of facility codes based on actual procedure that was performed in the ASC
+ Ensures appropriate modifier assignment to line level charges. Ensures Accurate linking of diagnosis and procedure codes, as needed to ensure accurate and compliant coding & billing.
+ Maintains quality and quantity of work that meets or exceeds benchmark standards
+ Identifies trends and opportunities for clinical documentation improvement. Provides CDI Educator or Revenue Integrity Educator/Auditor information for follow up with provider.
+ Educates staff and providers on missing or inadequate documentation in coordination with CDI Educator.
+ Monitors and maintains tracking of incomplete encounters to ensure that all documentation is completed timely and prior to the coding being complete. May work with Health Information Management team or Clinical Leaders to complete this task.
+ Communicates with physicians and other providers regarding outstanding documentation needs, including hospital and remote locations.
+ Provides administrative support to the billing staff including reviewing previously coded charges to facilitate the billing process.
+ Acts as resource to others for coding, documentation, claims denial related to medical necessity or coding
+ Resolves pre-claim submission edits to facilitate timely & accurate claims processing. Completes pre-billing edits assigned to coding and charge entry.
+ Timely and accurately inputs of paper and electronic clinic, surgical, facility, MRI, DME and physical therapy charges and time of service payments into Practice Management system in accordance with organizational standards.
+ Collaborates and assists in resolving denials that may be related to coding or documentation.Primary Responsibilities
+ Meets or exceeds quality and quantity metrics for job role based on benchmarked standards.
+ Maintains patient confidentiality according to state, federal and company regulations
+ Attends meetings, as assigned, and participate in educational activities to keep skills up to date
+ Stays current with payer regulations and policies
+ Maintains coding certification
+ Demonstrates professionalism at all times
+ Displays cooperative behavior and interacts positively and effectively with others to promote a team environment
+ Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues
+ Actively supports departmental and corporate strategic plans
+ Performs other duties necessary to maintain the overall efficiency and continuity of the clinicQUALIFICATIONS
+ High school graduate or GED. Associates degree preferred
+ Certified Professional Coder (CPC or other equivalent)
+ Minimum of 1 year of health care coding experience
+ Excellent attention to detail
+ Excellent customer service skills
+ Ability to make well-reasoned decisions, both independently and as part of a team
+ Ability to follow-through to meet patient, physician, and/or practice needs
+ Ability to use discretion in handling and confidential information
+ Ability to work independently and as part of a team
+ Ability to work collaboratively and effectively with individuals at all levels of the organization
+ Excellent time management and organizational skills
+ Proficient computer skills: Microsoft office including Word, Excel, PowerPoint and email/Outlook
+ Knowledge of regulatory, legislative and AAAHC/JCAHO standards related to medical billing and codingPHYSICAL DEMANDS / WORK ENVIRONMENT
+ Operation of various office equipment; fax machine, telephone & voice mail system, stationary/lap top computer, scanner, e-mail system, cell phone, pager, and copier
+ Light lifting of paperwork, folders or other general record keeping materials
+ Lifting of mail bins and boxes up to 25 lbs.
+ Light travel to various sites of service
+ May be required to sit or stand for extended periods of time
+ Occasional reaching, bendingBENEFITS AND PERKS
+ 401(k) Match and Profit Sharing Plan
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