Reviews progress notes to determine codes meet local and national medical necessity guidelines.
Assigns ICD-10 and CPT codes with the appropriate modifiers for services provided when posting charges.
Be familiar with medical terminology, LCD’s, NCD’s and insurance portals to stay compliant with industry coding practices. .
Monitor payer EOB’s/system for denials and improper payments.
Investigate and follow up on denied or rejected claims by sending corrected claims/appeals and contacting insurances as necessary.
Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.
Answer phones and handle patient calls regarding accounts for billing, as needed.
Key claims on MaineCare portal, as needed.
Verify insurance coverage and benefits prior to submitting claims to ensure proper reimbursement.
Collect, post and manage patient account payments
Collaborate with healthcare providers to resolve any discrepancies in billing or coding as requested by Billing Manager.
Actively participates in department meetings, one-on-one meetings and mentorship meetings with billing team members.
Serve as a resource and subject matter expert to other staff members (front office, providers, fellow team members).
Perform other related duties as requested.

Education and Experience:

Certification as a Professional Coder is preferred or a combination of education and/or experience in Medical Billing and Coding.
High School Diploma or G.E.D.
1-2 years of experience in the field preferred.
Able to have good communication skills with staff, clients, insurance companies, and the general public.
A certain degree of creativity is expected.

Essential Functions:

COMPREHENSION: Understands and applies non-routine verbal and/or written instructions.

ORGANIZATION: Organize and prioritize individual work schedule to manage multiple task and/or projects

DECISION MAKING: Makes decisions that have an impact on the immediate work unit’s operation and/or services.

COMMUNICATION: Communicates and explains a variety of information

PHYSICAL REQUIREMENTS: keyboard operation and sitting for extended periods of time. Ability to lift 25 lbs.; Walking/Standing/Bending/Kneeling/Squatting; Visual acuity for extended periods of monitor operation. Ability to use interfaced communication devices (Electronic Medical Record, telephone, internet, etc.)

Eastport Health Care, Inc.

Coding/Billing Specialist

About the Job