COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Coding/Reimbursement Spec.

  • Job ID: 834927608
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Pinnacle Health Medical Services - Admin
  • Department: PBO Business Operations
  • Location: 1200 Camp Hill Bypass, Camp Hill PA 17011
  • Union Position: No
  • Salary Range: $20.96 to $31.44 / hour

Description

Purpose:

Ensures that accurate claim submission and reimbursement has been met for all account types by identifying ICD-9, CPT and modifier usage thorough review of the medical record, which includes understanding anatomy, physiology, medical terminology, and disease processes, as well as payer reimbursement guidelines.

Responsibilities:

  • Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement while adhering to major payer regulations prohibiting unbundling, and resolve issues related to unlisted procedures or procedures with -22 modifier to ensure additional reimbursement.
  • Partner with providers and coders to investigate payers' coding and reimbursement policies for new and/or existing services.
  • Adhere to internal and system-wide competencies/behaviors, policies and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.
  • Contact payer representatives to discuss policy exceptions and make appeals to optimize reimbursement. Incorporate any necessary charges into the department's daily process flow.
  • Demonstrate proficiency in utilizing computer to access various software applications and resources essential to completing coding, edit, and denial processes efficiently, such as Epic (Resolute), payer reimbursement websites, and electronic medical record repositories.
  • Ensure adherence to all applicable SOX coding/reimbursement controls, including, but not limited to Decentral Edit/Denial Processes and Review of Controllable Losses.
  • Review applicable payer coding policy, submit appeals according to guidelines and update bulletins and communicate changes to coding staff and providers. Incorporate any necessary changes into the department's daily process flow.
  • Engage management to escalate issues when needed to assist in issue resolution.
  • Develop and maintain a thorough knowledge of the department's overall workflow with a general understanding of all functions and the importance of completing each task in a timely manner.
  • Make forward progress within the training 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 the management staff.
  • Provide education to staff and physicians to prevent similar edits or conflicting or ambiguous documentation in the future.
  • Perform reimbursement training for new coders.

Qualifications

  • High school graduate or equivalent.
  • Graduate of a CPC or a certified coding program preferred.
  • A minimum of 2 years experience with E/M and surgical CPT/ICD9 coding and 5 years payer reimbursement experience related to E/M and surgical coding in a hospital or provider office base setting or combined 7 years experience.
  • Must have experience with modifiers and their effect on payer reimbursement.
  • Must be able to problem solve effectively and be knowledgeable in medical terminology, human anatomy/physiology, pharmacology, pathology, principles of ICD-9-CM and CPT Classification Systems.
  • Must have experience with researching payer regulations and policies related to reimbursement.
  • Proficient computer skills required, including payer websites and excel.

Licensure, Certifications, and Clearances:

  • CPC or eligible preferred.
  • CCS acceptable.

UPMC is an Equal Opportunity Employer/Disability/Veteran

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

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   Current UPMC employees must apply in HR Direct

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