Senior Professional Fee Coding Specialist

UCSF•Emeryville, CA

9d•$53 - $66•Remote

About The Position

The Senior Professional Fee Coding Specialist, also referred to as a Patient Records Abstractor, functions as a Medical Coder for UCSF’s physician practices. This role involves reviewing patient records, discharge summaries, operative reports, and other clinical documentation to assign standardized codes for diagnoses, procedures, and services. The specialist applies national and international coding classifications to ensure accurate reimbursement and reliable clinical data. A strong understanding of Current Procedural Terminology (CPT), International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), and Healthcare Common Procedural Coding System (HCPCS) is essential. The position operates within a healthcare records or billing team and requires collaboration with clinicians, clinical coders, and administrative staff to resolve documentation queries. Key duties include staying current with coding updates, compliance requirements, and professional standards, participating in regular audits to monitor coding quality, processing assigned case volumes accurately and in a timely manner, adhering to confidentiality and information governance standards, and contributing to process improvements for enhanced data quality and coding efficiency.

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 maintain currency with coding updates, compliance requirements, and professional standards.
Ability to participate in regular audits to monitor coding quality.
Ability to process assigned case volumes in a timely manner while maintaining high accuracy.
Adherence to confidentiality and information governance standards.
Ability to contribute to process improvements that enhance data quality and coding efficiency.
Experience with charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
Experience resolving Claims Manager and Epic edits.
Experience with evaluation and management (E/M) leveling, diagnosis coding, bundling issues, and modifier usage.
Proficiency in using dashboards and reporting processes to analyze revenue cycle functions and audit data.
Experience completing coding-related work reports, reconciling charge lists, creating charge sessions, updating department information, and following up on credentialing requests.
Ability to serve as a lead resource on applicable billing, coding, and revenue cycle regulations.
Ability to communicate regulatory updates to faculty, management, and staff.
Ability to teach and train team members within designated specialty and subspecialty areas.
Ability to stay current with coding audits, regulations, trends, Office of Inspector General (OIG) initiatives, and payer requirements.
Ability to research and review coding directives issued by OIG, CMS, intermediaries, and national and local insurance carriers.
Ability to analyze complex coding data, identify revenue cycle trends, and prepare reports for leadership.

Responsibilities

Review and code complex patient encounters in assigned work queues.
Work in moderate and simple work queues as needed.
Process RFI and edit work queues as needed.
Maintain a minimum 95% coding accuracy rate.
Meet productivity standards established by UCSF leadership.
Collaborate proactively with clinical divisions to support compliant revenue cycle practices.
Code complex procedures and accounts requiring advanced expertise in charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
Resolve Claims Manager and Epic edits through documentation review, including evaluation and management (E/M) leveling, diagnosis coding, bundling issues, modifier usage, and related coding requirements.
Use dashboards and reporting processes to analyze complex revenue cycle functions and audit data supporting revenue cycle management.
Complete coding-related work reports, reconcile charge lists, create charge sessions, update department information, and follow up on credentialing requests.
Serve as a lead resource on applicable billing, coding, and revenue cycle regulations and communicate regulatory updates to faculty, management, and staff.
Teach and train team members within designated specialty and subspecialty areas.
Stay current with coding audits, regulations, trends, Office of Inspector General (OIG) initiatives, and payer requirements affecting assigned specialties.
Research and review coding directives issued by OIG, CMS, intermediaries, and national and local insurance carriers.
Analyze complex coding data, identify revenue cycle trends, and prepare reports for leadership.