Coder II, Profee (Orthopaedic Surgery)

UPMC; Pittsburgh (Allegheny County); On-site; USD 60,000 - 90,000; Full time

Job summary

UPMC Department of Orthopaedic Surgery is seeking a full-time Coder II to join their team. This daylight position runs Monday through Friday from 7:00 am to 3:30 pm with some flexibility.

The role reviews physician, nursing and ancillary documentation to assign accurate ICD and CPT codes, maximize reimbursement and resolve denials. CPC certification or completion of an approved coding program is preferred, with 3 years' experience or CPC required.

Qualifications

• High school graduate or equivalent.
• Graduate of an approved certified coding program preferred.
• Eligible for CPC or CPC specialty certification.

Responsibilities

• Review all pertinent physician, nursing and ancillary documentation in the medical record.
• Determine level of acuity, procedure(s) performed, billable supplies and diagnosis to substantiate medical necessity.
• Review and sequence all codes to maximize reimbursement and address any potential bundling issues.
• Apply modifiers as needed.
• Edit according to LMRP/CCI and coding denial resolution.
• Identify incomplete documentation and formulate physician queries for clarification.
• Monitor and resolve coding edits and denials to ensure optimal reimbursement.
• Adhere to coding guidelines and participate in ongoing education.

Education

High school diploma or equivalent

Certified coding program

CPC certification

Tools

MS Excel

Job description

UPMC Department of Orthopaedic Surgery is hiring a full-time Coder II to join their team! This is a Monday through Friday daylight position with no evenings or weekends. Hours are 7am to 3:30pm, but have some flexibility.

Purpose:

Same responsibilities as a Coder I. Review all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, determine level of acuity, procedure(s) performed, billable supplies and diagnosis to substantiate medical necessity. Review and sequence all codes 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.
• High school graduate or equivalent.
• Graduate of an approved certified coding program preferred.
• Curriculum includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures.
• Proficient computer skills with MS excel knowledge preferred.
• In lieu of 2 years of coding experience with schooling, a minimum of 3 years experience or CPC certification required.

Licensure, Certifications, and Clearances:

Eligible for CPC or CPC specialty certification.

• Act 34 with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran