Certified Coding Specialist I-Profee

UPMC Corporate Revenue Cycle is hiring a Certified Coding Specialist I to join our Coding Department to support our Denials Team! This position will be a work-from-home position working Monday through Friday during business hours.

As the Certified Coding Specialist I, you will have the same responsibilities of Certified Specialty Coder, plus provide training on code selection for new and existing staff. You will be perform audits to determine code and charge selection accuracy and summarize coder accuracy for Managers. Additionally, you will identify topics for training and education, research topics, and assist with the assembly of training materials and CDI process. Assist with audit reviews, including all internal, external and RAC associated coding audits. Review and approve adjustments to accounts. In addition to the responsibilities listed, the Certified Coding Specialist I will be responsible for supervising on-site staff.

Responsibilities:

• Adhere to internal system-wide policies, competencies, behaviors and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.
• Utilize advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
• Supervises staff including assignments and Kronos approval and signoff. Also assist with recruitment.
• Code all diagnoses and procedures by assigning and verifying the proper ICD and CPT codes. Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding.
• Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process.
• Investigate and resolve reimbursement issues, including denials, in a timely manner and demonstrate proficiency on billing system.
• Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling. Prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
• Advise and instruct coders/providers regarding billing and documentation policies, procedures, and regulations; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
• Progress within the training period toward meeting departmental coding accuracy standards within the first year of employment by assigning correct principal diagnosis/procedure, complications and co-morbidities, and secondary diagnoses as reviewed by the designated trainer. Coder should meet appropriate coding productivity standards within the time frame established by management staff.
• Train all new Coders to observe established coding guidelines and to utilize the appropriate billing system.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• Lead, participate in and/or assist with departmental coding audits.
• Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.

• High school graduate or equivalent.
• Five years of surgical coding experience (includes anesthesia coding) OR advanced E/M coding experience.
• Graduate of an approved certified coding program preferred.

•  Proficient computer skills with MS excel knowledge preferred

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  Licensure, Certifications, and Clearances:
   

• CPC or Certified Coding Specialist (CCS) specialty certification required
• Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran