Professional Fee Medical Coder II

UCSF•Emeryville, CA

1d•$51 - $63•Remote

About The Position

The Professional Fee Medical Coder II role, also referred to as Patient Record Abstractor, is responsible for reviewing patient records, discharge summaries, operative reports, and other clinical documentation to assign standardized codes for diagnoses, procedures, and services. This role applies national and international coding classifications to ensure accurate reimbursement and reliable clinical data. The position requires knowledge of Current Procedural Terminology (CPT), International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), and Healthcare Common Procedural Coding System (HCPCS). The role operates within a healthcare records or billing team and necessitates close collaboration with clinicians, clinical coders, and administrative staff to resolve documentation queries. Coders must stay current with coding updates, compliance requirements, and professional standards, and participate in regular audits to monitor coding quality. Expectations include timely processing of case volumes while maintaining high accuracy, adherence to confidentiality and information governance standards, and contributing to process improvements that enhance data quality and coding efficiency. The Faculty Practice Revenue Management Operations (FPRMO) department, which this role supports, is responsible for physician-based coding for UCSF faculty, ensuring accurate code assignment for professional services across various UCSF locations and affiliated facilities. FPRMO supports a diverse group of providers across a wide spectrum of specialties within an academic medical center environment and plays a critical role in the revenue cycle by delivering precise and compliant coding for approximately 1.6 million patient encounters annually.

Requirements

Knowledge of Current Procedural Terminology (CPT).
Knowledge of International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM).
Knowledge of Healthcare Common Procedural Coding System (HCPCS).
Ability to resolve documentation queries.
Ability to maintain currency with coding updates, compliance requirements, and professional standards.
Ability to participate in regular audits to monitor coding quality.
Ability to maintain high accuracy.
Adherence to confidentiality and information governance standards.
Contribution to process improvements that enhance data quality and coding efficiency.
Ability to work in moderate work queues daily.
Ability to work in simple work queues as needed.
Ability to work RFI and edit work queues as needed.
Maintain or exceed a 95% accuracy rate.
Maintain productivity standards.
Ability to work proactively with divisions in areas of specialization.
Ability to code intermediate procedures/accounts requiring advanced knowledge in charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
Ability to resolve Claims Manager and Epic edits.
Ability to apply dashboards and processes for continuous analysis of moderate revenue cycle functions of diverse scope.
Ability to audit data input to support revenue cycle management.
Ability to complete coding work reports, reconcile charge lists, create charge sessions, update DEPs, follow up on credential requests, and perform related coding activities.
Ability to verify and correct statistical data abstracted and compiled by lower-level staff, reconcile output statistics, and perform medical coding.
Ability to review APeX PB Charge Edit and RFI work queues daily or as assigned.
Ability to address payor inquiries requiring department review.
Ability to resolve claim edits to ensure timely billing.
Ability to proactively review assigned work queues.
Ability to collaborate with faculty and ancillary providers regarding required documentation changes and updates.
Ability to run reports related to assigned charges, including missing charge reports, error reports, and other reports supporting charge capture, error resolution, and throughput.
Under supervision, ability to analyze charge integrity, reconciliation, and charge linkages from ancillary charging systems for the medical center/health system.

Responsibilities

Work in moderate work queues daily as defined by UCSF leadership.
Work in simple work queues as needed.
Work RFI and edit work queues as needed.
Maintain or exceed a 95% accuracy rate.
Maintain productivity standards as defined by UCSF leadership.
Work proactively with divisions in areas of specialization to assure appropriate revenue cycle practices and compliance with internal and external regulations.
Code intermediate procedures/accounts requiring advanced knowledge in charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
Resolve Claims Manager and Epic edits to ensure correct coding of services provided, including review of documentation for correct coding, evaluation and management (E/M) leveling, diagnosis coding, bundling issues, and modifier usage.
Apply dashboards and processes for continuous analysis of moderate revenue cycle functions of diverse scope.
Audit data input to support revenue cycle management.
Complete coding work reports, reconcile charge lists, create charge sessions, update DEPs, follow up on credential requests, and perform related coding activities.
Verify and correct statistical data abstracted and compiled by lower-level staff, reconcile output statistics, and perform medical coding.
Review APeX PB Charge Edit and RFI work queues daily or as assigned, address payor inquiries requiring department review, and resolve claim edits to ensure timely billing.
Proactively review assigned work queues and collaborate with faculty and ancillary providers regarding required documentation changes and updates.
Run reports related to assigned charges, including missing charge reports, error reports, and other reports supporting charge capture, error resolution, and throughput.
Under supervision, analyze charge integrity, reconciliation, and charge linkages from ancillary charging systems for the medical center/health system.