Medical Coding and Billing Specailist Full Time 40 hours

At Bristol Health, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents, and families. We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect, and Empathy (C.A.R.E.). We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice.

The Medical Coding and Billing Specialist is responsible for reviewing provider documentation and abstracting professional services to ensure accurate code assignment, charge integrity, claim compliance, and appropriate reimbursement. This role performs provider progress note abstraction; reviews, corrects, adds, or deletes CPT/HCPCS, modifier, and ICD-10-CM diagnosis codes as supported by documentation; analyzes coding-related denials and edit failures; identifies denial trends; helps implement rules and edits within applicable systems; and provides coding and documentation education to providers, MSG offices, and hospital departments.

Essential Job Functions and Responsibilities:

• Reviews provider progress note, procedure note, and related medical record documentation to abstract billable professional services accurately and timely.
• Assigns, reviews, validates, and when appropriate corrects, adds, or deletes CPT, HCPCS, modifier, and ICD-10-CM diagnosis codes based on provider documentation, coding guidelines, payer requirements, and internal billing rules.
• Performs charge review and coding reconciliation for professional services to ensure encounters are coded completely, accurately, and in compliance with payer and regulatory requirements.
• Reviews coding-related denials and edit failures, including but not limited to denials for: MUE, NCCI edits, modifier-related, diagnosis/procedure mismatch, invalid or missing diagnosis.
• Identifies opportunities to reduce preventable denials by recommending and helping implement edits, rules, review workflows, and system controls within applicable billing and clinical systems.
• Applies and maintains coding and billing edits in coordination with operational (Vitalware/AMA Coding Guidelines), billing, revenue integrity, and information systems teams to support compliant claim generation and clean claim performance.
• Communicates directly with providers and designated office staff regarding documentation clarification, coding corrections, missing elements, modifier use, diagnosis specificity, and other issues needed to support compliant billing.
• Provides education and feedback to providers.
• Performs retrospective and prospective coding reviews to identify missed charges, unsupported codes, documentation deficiencies, and compliance risks.
• Collaborates with fellow coding team as well with billing, compliance, and departmental leadership to resolve coding issues, improve workflows, and support reimbursement optimization while maintaining coding compliance.
• Works assigned work queues, reports, edits, and denial inventories in a timely manner and meets productivity and accuracy expectations.
• Uses Meditech and eClinicalWorks to review documentation, manage encounters, apply coding updates, and support charge and billing workflow.