Coder I - Profee (Denials)

UPMC

10h•Remote

About The Position

UPMC Corporate Revenue Cycle is hiring a Coder I- Profee to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. This position will be working on Professional (Physician) Coding Denials. We are looking for Coders who have denials experience. In this role, you will assign ICD and limited CPT codes. The Coder will review the physician documentation to determine the appropriate ICD-10 code and primarily verify the CPT code, but in some cases, you may assign basic CPT codes. You will resolve basic coding edits, complete charge processing, and ensure diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered. This will require knowledge of billing and coding guidelines. Additionally, you will utilize coding resources (CCI edits, 3M, ICD and CPT Publications) along with any other applicable specialty reference material to ensure accurate coding.

Requirements

High school graduate or equivalent.
6 months experience (in lieu of completed coding externship).
Proficient computer skills with MS excel knowledge preferred.
Act 34

Nice To Haves

Graduate of an approved certified coding program preferred with a curriculum that includes Anatomy and Physiology, Medical Terminology, ICD-9-CM/ICD-10 and CPT Coding Guidelines and Procedures.

Responsibilities

Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD and CPT for all records to ensure accurate reimbursement.
Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
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.
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.
Utilize computer applications and resources essential to completing the coding process and to resolve basic coding edits efficiently.
Refer problem accounts to appropriate coding or management personnel for resolution.
Meet and maintain charge lag and coding productivity standards within the time frame established by management staff.
Adhere to internal 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.
Make forward progress within the training 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.