Coder II - Technical

UPMC

10d•Remote

About The Position

UPMC Corporate Revenue Cycle is hiring a Coder II for its Coding Department. This work-from-home position follows a Monday-through-Friday schedule during business hours. The role codes diagnoses and procedures using ICD-10 and CPT codes and charges for injection, infusion, hydration, and observation hours. UPMC is seeking candidates with prior same-day surgery coding experience. The Coder II reviews medical records and assigns and verifies diagnosis and procedure codes to support accurate reimbursement. The role uses coding guidelines, references, acuity-level guidance, hospital information systems, encoders, and electronic medical record repositories. It also includes identifying documentation gaps, querying physicians when needed, referring problematic accounts for resolution, maintaining productivity records, and participating in continuing education and coding meetings.

Requirements

High school diploma or GED equivalent.
Completion of an AHIMA- or AACP-certified coding program or certificate, Bidwell Training School, or an equivalent program covering Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, and ICD-10-CM and CPT Coding Guidelines and Procedures.
For outpatient coding, pharmacology is taught on the job during training; pathophysiology coursework is not required.
For inpatient coding, coursework in Pharmacology and Pathophysiology is required.
Two years of hospital coding experience.
Eligible for RHIA, RHIT, or CCS.
Act 34 clearance with renewal.

Nice To Haves

Prior same-day surgery coding experience.

Responsibilities

Review coding for accuracy and completeness before submission to the billing system, using CCI edits.
Apply standard coding guidelines, principles, and coding references to assign appropriate ICD-10-CM, CPT, and DSM IV codes for all record types.
Use ACEP acuity-level guidelines or the hospital-specific acuity-level module as appropriate for ED coding.
Follow department policies and procedures, participate in monthly coding meetings, and contribute suggestions for operational improvements.
Maintain continuing education through seminars and review of updated CPT Assistant guidelines and coding clinics.
Progress toward coding accuracy standards of 98% within the first year and meet productivity standards within management-established time frames.
Code diagnoses and procedures, verify proper ICD-10-CM and CPT codes (and DSM IV when applicable), and assign principal and secondary diagnoses and procedures based on available documentation.
Use hospital information systems, encoders, and electronic medical record repositories to complete coding efficiently.
When applicable, abstract required medical and demographic information from records, enter it into the appropriate information system, and correct erroneous data after comparing records with system entries.
Refer problem accounts to appropriate coding or management personnel for resolution.
Complete assignments on time, understand departmental workflow, maintain daily productivity statistics, and submit a weekly productivity sheet to management.
Determine diagnoses treated, monitored, and evaluated and procedures performed during the episode of care; review relevant chart documents and assign appropriate codes.
Sequence diagnoses and procedures according to clinical significance to assign the appropriate DRG, APC, ASC, payment tier, or DSM IV methodology for accurate reimbursement.
Identify incomplete medical-record documentation and formulate physician queries to obtain missing information or clarification; consult a DRG Specialist during the query process when applicable.