Job Description

Job Title: Coder II, Profee
Job ID: 721850
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: MULTI Tri Rivers Admin
Location: 7500 Brooktree Road, Wexford PA 15090

Description

Purpose:
Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for a Coder II (Profee) to join this community as well.

This role has the same responsibilities as a Coder I.  The Coder II reviews all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, the Coder determines the level of acuity, procudure(s) performed, billable supplies and diagnosis to substantiate medical necessity. The Coder reviews and sequences all codes to maximize reimbursement and address any potential bundling issues. They apply modifiers as needed. LMRP/CCI edit and coding denial resolution.

This role is Monday through Friday during daylight hours onsite at their Brooktree Road or Babcock Boulevard location.  

Responsibilities:
  • Adhere to internal department 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.
  • 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.
  • Make forward progress within the 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 staff.
  • Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff.
  • Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement.
  • Refer problem accounts to appropriate coding or management personnel for resolution.
  • Utilize computer applications and resources essential to completing the coding process efficiently.
  • Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.

Qualifications

  • High school graduate or equivalent. 
  • Graduate of an approved certified coding program preferred. 
  • Curriculum includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-10-CM and CPT Coding Guidelines and Procedures. 
  • Proficient computer skills with MS excel knowledge preferred. 
  • In lieu of two years of coding experience with schooling, a minimum of three years experience or Certified Professional Coder (CPC) certification required.

  • Licensure, Certifications, and Clearances:
    Eligible for CPC or CPC specialty certification.

    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $14.95 to $22.97

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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