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BHI Valley St - Bristol, CT 06010

Position Type Full Time Job Shift 1st Shift (Days) Education Level High School

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.

• 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.

Minimum Requirements:

• High school diploma or equivalent
• At least 2-4 years of experience in professional coding, medical billing, charge review, denial analysis, or closely related healthcare revenue cycle work preferred
• Strong understanding of CPT/HCPCS codes, ICD-10-CM diagnosis coding, modifiers, and medical terminology
• Experience reviewing provider documentation and abstracting services from progress notes and other clinical documentation
• Experience reviewing and resolving coding denials, including MUE, NCCI/NCCO, modifier, medical necessity, diagnosis mismatch, and documentation-related denials preferred
• Experience with Professional Billing preferred
• Experience with Meditech and eClinicalWorks strongly preferred
• Basic understanding of insurance terminology and payer guidelines
• Coding certification required (CPC, CCS, CIC, COC, CBCS,CMC).

Key Skills:

• Provider note abstraction and coding review
• CPT/HCPCS, ICD-10-CM, and modifier knowledge
• Denial analysis and trend identification
• Knowledge of MUE and NCCI/NCCO edit logic
• Medical terminology and documentation interpretation
• Critical thinking and root cause analysis
• Experience with Meditech and eClinicalWorks

Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.