Coder III - Technical

UPMC•Pittsburgh, PA

9d•Remote

About The Position

UPMC Corporate Revenue Cycle is hiring a Coder III for its Coding Department. This is a work-from-home position scheduled Monday through Friday during business hours. The role monitors and responds to Pre-Bill edit and error reports, performs PHC4 coding corrections, and provides feedback to coders about errors. The Coder III also monitors the Daily Cirius Error report to ensure accounts do not exceed the expected completion timeframe, addresses Pre-Bill Edit report issues to support timely billing, assists with training other coders as requested, and contributes to special projects. The position determines and codes diagnoses treated, monitored, and evaluated, as well as procedures performed during episodes of care. It requires reviewing medical records and related documentation, sequencing diagnoses and procedures according to clinical significance, and assigning codes that support accurate reimbursement. The coder reviews coding for accuracy and completeness before billing, identifies documentation gaps and formulates physician queries, refers problem accounts for resolution, maintains productivity records, and participates in ongoing education and department improvement efforts.

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.
Three years of hospital coding experience.
Minimum of three years of CPT coding experience.
Strong background in Interventional Radiology (IR) and Interventional Cardiology (IC) CPT coding.
Requires one of the following credentials: CCS, RHIT, RHIA, or Certified Professional Coder certification; listed credentials include CCS, CPC, NRCCS, RHIA, or RHIT.
Act 34 clearance.

Nice To Haves

CIRCC (Certified Interventional Radiology and Cardiovascular Coder) credential is preferred.

Responsibilities

Monitor and respond to accounts on Pre-Bill edit and error reports.
Perform PHC4 coding corrections and provide feedback to coders who made errors.
Monitor the Daily Cirius Error report to ensure accounts do not exceed the expected completion timeframe.
Review and respond to Pre-Bill Edit report issues to ensure timely billing.
Assist with training other coders as requested and assist with special projects.
Determine diagnoses treated, monitored, and evaluated, and procedures performed during the episode of care; review patient chart documents and assign appropriate codes.
Sequence diagnoses and procedures according to clinical significance to support accurate DRG/APC/ASC, payment-tier, or DSM IV assignment and reimbursement.
Code diagnoses and procedures using and verifying appropriate ICD-10-CM and CPT codes, and DSM IV codes when applicable; assign principal and secondary diagnoses and procedures based on available documentation.
Work toward the coding accuracy standard of 98% within the first year and meet productivity standards established by management.
Follow department policies and procedures, participate in monthly coding meetings, and share suggestions for operational improvements.
Maintain continuing education through seminars and review of updated CPT Assistant guidelines and coding clinics.
Complete assignments on time, understand department workflow, maintain daily productivity statistics, and submit a weekly productivity sheet to management.
Identify incomplete medical-record documentation and formulate physician queries to obtain missing information or clarification; consult DRG Specialists when applicable.
Refer problem accounts to appropriate coding or management personnel for resolution.
Review coding for accuracy and completeness before submission to the billing system, using CCI edits and standard coding guidelines, principles, and coding clinics.
Use ACEP acuity-level guidelines or a hospital-specific acuity-level module for ED coding, as applicable.
Use computer applications and resources, including hospital information systems, encoders, and electronic medical record repositories, to complete coding efficiently.
Abstract required medical and demographic information when applicable, enter it into the appropriate information system, and correct erroneous data by comparing system entries with the medical record.