Coder II, PSD – Regional Health Services

UPMC Health Plan, Inc.; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

UPMC Health Plan, Inc. is seeking a Coder II, PSD for a full-time, remote role. The position follows a Monday through Friday day shift with some schedule flexibility and occasional travel to practices for coding education and staff training.

The candidate will review documentation, determine level of acuity, and sequence codes to maximize reimbursement while applying modifiers and resolving denials. CPC certification eligibility is supported by the employer.

Qualifications

• 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.

Responsibilities

• Refer problem accounts to appropriate coding or management personnel for resolution.
• Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff.
• Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement.
• 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.
• Utilize computer applications and resources essential to completing the coding process efficiently.
• Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement.
• Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
• Make forward progress within the period toward meeting coding accuracy standards of the departments within the first year of employment.
• 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.
• 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.

Skills

Medical coding

MS Excel

Education

High school diploma

Certified coding program

Anatomy & Physiology

Pharmacology

Pathophysiology

Medical Terminology

ICD-9-CM & CPT guidelines

CPC certification eligible

Tools

CPT Assistant

Coding clinics

Job description

UPMC’s Regional Health Services is seeking a Coder II, PSD to join their team! This full-time position will work Monday through Friday, day-shift, with some schedule flexibility. This is a work-from home position. Occasional travel to practices may be requested to provide coding and billing education to providers and staff.

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, procudure(s) performed, billable supplies and diagnosis to substantiate medical necessity. 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:

• Refer problem accounts to appropriate coding or management personnel for resolution.
• Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff.
• Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement.
• 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.
• Utilize computer applications and resources essential to completing the coding process efficiently.
• 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.
• 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.
• 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.
• 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.

Qualifications:

• 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 31 Child Abuse Reporting with renewal
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal