Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Coding Specialist I is responsible for training and coaching providers on documentation, coding and reimbursement requirements. Performing annual QA’s to provider compliance. Researching all new services offered by the DSO and to ensure reimbursement. Responsible for assisting Billing Specialists with denials based on codes and modifiers. Stay up to date on any changes to CPT codes and documentation requirements to ensure compliance by all providers. Reviewing hold buckets daily for charges requiring corrected coding. Travel between the CBO and all clinical sites is expected.
Job Description
Key Outcomes:
- Conducts educational sessions with providers and clinical staff as needed
- Conducts review of all charges to ensure provider coding is compliant with national coding and payer specific guidelines.
- Performs chart audits to ensure services are coded correctly following the Federal, State and payer specific coding requirements and meet the Corporate Code of Ethics.
- Provides coding instructions and input on all coding changes following Federal, State and payer reimbursement requirements
- Reviews all hospital and invoice services to ensure they are coded correctly, as well as data entry and reconciliation of daily batches.
- Ensures the Company Code of Ethics and Compliance plans are followed
- Reviews monthly audit reporting to create any claims that have been missed during our standard process
- Supports Claims Creation and Billing Specialists in reviewing all yearly CMS CPT changes to educate the sites and adjust the claims process as needed
Education/Experience:
- Certification as a coding specialist (CPC) required
- Associate Degree or combination of relevant education and experience
- 2+ years professional coding experience
- Chart auditing and educating preferred
- Previous billing experience preferred
Required License(s) and/or Certification(s):
Skills/Knowledge/Competencies (Behaviors):
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Excellent customer service, written and oral communication skills
- Knowledge of chart auditing following correct coding guidelines
- Knowledge of patient Billing policies and procedures
- Ability to work independently and as a team member with minimal direct supervision and effectively implement oral and written instructions.
- Maintains an active role in professional development and continuing education
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]
Top Skills
What We Do
Martin’s Point Health Care is an innovative not-for-profit health care organization offering high-quality, affordable health care and coverage to the people of Maine and throughout New England.
Martin’s Point has seven health care centers in Maine and New Hampshire offering primary and specialty care to those with most major health insurance plans. Martin’s Point also administers two health insurance plans: Generations Advantage—with the only 5-Star Medicare Advantage plans in northern New England, and the US Family Health Plan for active duty military families and retirees throughout most of northern New England and New York.
We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. Martin’s Point is dedicated to creating a community of healthy people through authentic relationships and trust
