Job Description

Job Title: Quality Assurance Coding Specialist II
Job ID: 673582
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: MEDICARE HCC
Location: 600 Grant St, Pittsburgh PA 15219


The HealthPlan with UPMC is searching for a new Quality Assurance Coding Specialist II!  This role is responsible for quality review/monitoring of Health Plan Coding Specialist Staff or external coding personnel. This role performs auditing functions including monitoring, coding of diagnosis, reviewing medical record documentation and discharge summaries to determine if the appropriate code was assigned to ensure Health Plan compliance with coding standards. The position also provides coding related support to internal Quality Assurance/Fraud and Abuse staff.

This position is located in Pittsburgh at the US Steel Tower, Monday- Friday during daylight hours.  Sound like the job for you?  Apply today!

  • Assists Manager with research, resolution and response of error appeals/rebuttals
  • Communicate effectively with Risk Adjustment Staff, nurse reviewers and physicians and ancillary departments as necessary to address issues and concerns.
  • Compile and report statistical data to internal and external customers
  • Completion of special projects including claims and/or coding related audit support.
  • Identify error trends to determine appropriate training needs and suggest modification to policies and procedures
  • Maintain employee/insured confidentiality. Provide assistance to other departments as requested. Compile and report statistical data to internal and external customers.
  • Provide training to new Coding team staff as needed.
  • Responds to the needs of internal Health Plan Departments (Risk Adjustment, Medicare or FWA etc.) and external customers (Ovation, Health System Coding Team, etc.)
  • Review Diagnosis codes submitted internal/external coders/reviewers and the medical record documentation to ensure the recommended diagnosis code and meets governmental agency requirements for submission.
  • Utilize standard coding guidelines, principles and coding clinics to verify the appropriate ICD-10-CM, CPT codes modifiers, or DRG/APC for accurate coding assignment.
  • Working knowledge of entering audits into the database and use of medical records repository systems.


  • Associates degree from an accredited Health information Management program preferred
  • Three to five years Hierarchical Condition Categories (HCC) auditing experience 
  • Graduate of an AHIMA or AAPC Certified Coding program
  • Five years of coding experience in a health care setting
  • Extensive knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures is required. 
  • In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required 
  • The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential
  • Excellent written and verbal communication skills are essential
  • Proficiency in computer skills required for coding (MARS, Cerner)
  • Detail oriented individual with excellent organizational skills
  • High degree of oral and written communication skills
  • Proficiency in MS Office/PC skills
  • Traveling may be required as necessary.

Licensure, Certifications, and Clearances:
Certified Professional Coder (CPC) OR Certified Coding Specialist (CCS) OR Registered Health Information Technician (RHIT) OR Registered Health Information Administrator (RHIA)

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

Salary Range: $24.27 to $41.99

Union Position: No

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