Compliance Billing and Coding Specialist - Spectrum Medical Group - South Portland, ME |
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Compliance Billing and Coding Specialist

Spectrum Medical Group | South Portland, ME

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Come join our Compliance Team as a Compliance Billing and Coding Specialist!
Spectrum Medical Group, a multi-specialty, healthcare organization, is currently recruiting for a Compliance Billing and Coding Specialist. This individual will support the “requests for additional information” (RAI) asked by the billing vendor to support submission of claims, for all specialties within Spectrum Medical Group. Responsibilities include participating in the design/implementation processes of the billing procedure to ensure the clinical review cycle is properly utilized and identifying trends within the function of the role. The successful candidate will assist in billing and coding compliance audit work plans to evaluate and determine opportunities for continuous improvement. This role will operate in a consultative manner with physicians, clinical managers, and administrative staff by providing education and additional resources related to compliance, coding, billing and documentation best practices.

· Act as a resource and point of contact for physicians, management, and administrative staff for auditing, billing and coding services and RAI’s for all divisions

· Create, maintain and distribute documentation templates, clinical references and resources, and compliance educational materials for physicians and ancillary staff

· Maintain all specialty specific billing and coding compliance guidelines in accordance with regulatory and accreditation requirements

· Partner with the practice managers to resolve issues identified through patterns and trends in the RAI system

· Consult to resolve issues related to coding, coverage and reimbursement resolutions, pre-authorizations, denials and appeals for claims and medical policy

· Assist in gathering, reviewing and understanding Medicare and private insurance policies

· Assists in performing a variety of auditing assignments to promote compliance with government rules and regulations

· Maintain the database of audit findings for reporting purposes

· A graduate of a formal program in medical coding from a vocational-technical high school, post-secondary vocational school, community or junior college; or a graduate of a post-secondary program with a certificate or diploma (1yr program) or an Associate’s degree

· A minimum three years’ experience in coding and compliance health care in a clinical and/or administrative hospital/medical setting preferred

· Certification in Coding (e.g. CPC)

· Detailed understanding of government requirements/expectations for healthcare compliance programs, compliance auditing, Medicare and Medicaid programs, as well as other insurance payor guidelines

· Strong analytical, interpersonal and organizational skills

· Ability to work collaboratively with others and independently in order to accomplish goals

· Thorough understanding of state and federal compliance laws

· Ability to counsel and interface with all levels of employees

· Ability to interpret and apply company policies and procedures

· Effective communication and presentation skills

· Computer knowledge including MS Word, Excel, Power Point and database/intranet research skills and willingness to learn other applications as needed.

Position is Full-time (M-F), offers a supportive, team-oriented environment with a competitive salary, and outstanding benefits package: 401(k) and profit sharing plan, health insurance, medical reimbursement, life insurance, long-term & short-term disability, and paid time off. We are an equal opportunity employer. M/F.
Posted On: 02/27/17
Telecommute: No
Categories: Healthcare, Professional Services
Job Type: Regular
Job Status: Full Time
Pay Type: Hourly Wage
Similar Jobs: Within 25 miles of 04106, Healthcare, Professional Services
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To apply to this job: click APPLY to submit your resume to this employer.

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