Coder II, Profee

UPMC; Pittsburgh (Allegheny County); Remote; USD 55,000 - 75,000; Full time

Job summary

UPMC in Pittsburgh is hiring a Coder II to join the Coding Department. This is a work-from-home position with standard weekday hours.

You will review physician, nursing and ancillary documentation, determine acuity, procedures, and codes to substantiate medical necessity. Strong cardiology coding background preferred.

Responsibilities include applying ICD/CPT codes, modifiers, and resolving denials to maximize reimbursement while meeting productivity targets.

Qualifications

• Strong understanding of cardiology coding.
• Experience in professional coding across physician records.
• Ability to apply CPT/ICD codes and modifiers correctly.

Responsibilities

• Utilize computer applications and resources essential to the coding process efficiently.
• Meet and maintain charge lag and coding productivity standards within management guidelines.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• Identify incomplete documentation and formulate physician queries to obtain missing information.
• Monitor and resolve coding edits and denials to ensure optimal reimbursement.
• Apply standard coding guidelines and clinics to assign ICD and CPT codes.

Skills

Cardiology coding

Medical coding

ICD/CPT coding

Tools

Coding software

Job description

UPMC Corporate Revenue Cycle is hiring a Coder II to join our Coding Department! This position will be a work-from-home position, working Monday through Friday during business hours.

In this position, you will be working on professional coding. We are looking for individuals with a strong understanding of cardiology coding. As a Coder II, you will review all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, you will determine the level of acuity, procedure performed, billable supplies and diagnosis to substantiate medical necessity. You will review and sequence all codes to to maximize reimbursement and address any potential bundling issues. Apply modifiers as needed. LMRP/CCI edit and coding denial resolution.

Responsibilities:

• Utilize computer applications and resources essential to completing the coding process efficiently.
• Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• 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.
• Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement.
• Make forward progress within the period toward meeting coding accuracy standards of the departments within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff.
• Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
• Adhere to internal department and system-wide competencies, behaviors, policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by reviewing updated CPT assistant guidelines and updated coding clinics.
• Complete work assignments in a timely manner and understand the workflow of the department. Maintain daily productivity statistics and submit a weekly productivity sheet to management.