Description

Purpose:
Assign ICD and limited CPT codes. Coder reviews the physician documentation to determine the appropriate ICD-9 code and primarily verifies the CPT code, but in some cases assigns basic CPT codes. Resolves basic coding edits. Completes charging process. Ensures diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered-- requires knowledge of billing and coding guidelines. Utilize coding resources (CCI edits, 3M, ICD and CPT Publications) along with any other applicable specialty reference material to ensure accurate coding.

Responsibilities:

• Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD and CPT for all records to ensure accurate reimbursement. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
• 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.
• Utilize computer applications and resources essential to completing the coding process and to resolve basic coding edits efficiently.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• Meet and maintain charge lag and coding productivity standards within the time frame established by management staff.
• Adhere to internal 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.
• 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 management.

Qualifications

• High school graduate or equivalent.
• Graduate of an approved certified coding program preferred.  In lieu of completed coding externship, 6 months experience.
• Curriculum includes Anatomy and Physiology, Medical Terminology, ICD-10-CM and CPT Coding Guidelines and Procedures.
• Proficient computer skills with MS excel knowledge preferred.

Licensure, Certifications, and Clearances:

• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal


• UPMC is an Equal Opportunity Employer/Disability/Veteran

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