Job Description

Job Title: Certified Coding Specialist I
Job ID: 1800008G
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Rev Cyc Coding
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description

Are you looking for the next step of your coding career?  UPMC is hiring a Certified Coding Specialist I.  This role has the same responsibilities of Certified Specialty Coder, plus they provide training on code selection for new and existing staff.  The Coding Specialist performs audits to determine code and charge selection accuracy. They summarize coder accuracy for managers, identify topics for training and education, research topics, and assists with the assembly of training materials and CDI process.  The specialist assists with audit reviews including all internal, external and RAC associated coding audits. They supervise on-site staff and reviews/approves adjustments to accounts. They may be responsible for Kronos approval and sign off.

The role is Monday through Friday during daylight hours and located at the Quantum Building in Pittsburgh.  The Certified Coding Specialist will have the opportunity to work from home after training is complete.  

Responsibilities:
  • Adhere to internal system-wide policies, competencies, behaviors and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.
  • Advise and instruct coders/providers regarding billing and documentation policies, procedures, and regulations; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
  • Code all diagnoses and procedures by assigning and verifying the proper ICD and CPT codes. Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding.
  • 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.
  • Investigate and resolve reimbursement issues, including denials, in a timely manner and demonstrate proficiency on billing system.
  • Lead, participate in and/or assist with departmental coding audits.
  • Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling. Prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
  • Progress within the training period toward meeting departmental coding accuracy standards within the first year of employment by assigning correct principal diagnosis/procedure, complications and co-morbidities, and secondary diagnoses as reviewed by the designated trainer. Coder should meet appropriate coding productivity standards within the time frame established by management staff.
  • Refer problem accounts to appropriate coding or management personnel for resolution.
  • Supervises staff including assignments and Kronos approval and signoff. Also assist with recruitment.
  • Train all new Coders to observe established coding guidelines and to utilize the appropriate billing system.
  • Utilize advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
  • Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.

Qualifications

  • High school graduate or equivalent. 
  • Graduate of an approved certified coding program preferred. 
  • Proficient computer skills with MS excel knowledge preferred. 
  • Five years surgical coding experience (includes anesthesia coding) OR advanced E/M coding experience.

Licensure, Certifications, and Clearances:
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) specialty certification required

  • Certified Coding Specialist or Certified Professional Coder or Registered Health Information Administrator or Registered Health Information Technician

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

Salary Range: $22.60 to $39.11

Union Position: No

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