Job Description

Job Title: Coding/Reimbursement Specialist
Job ID: 732096
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Rev Cyc Coding
Location: 3330 Peach Street, Erie PA 16508

Description

Purpose:
Are you looking to take the next step in your coding career?  UPMC is searching for a Coding/Reimbursement Specialist to join their Revenue Cycle team!  This position ensures that accurate claim submission and reimbursement has been met for all account types by identifying ICD-10, CPT and modifier usage throughout review of the medical record.  This would require understanding anatomy, physiology, medical terminology, and disease processes, as well as payer reimbursement guidelines.

This full time position is Monday through Friday during daylight hours.  It can be located in Erie at the Sterling Square location or Pittsburgh at the Quantum building location.  Sound like a fit?  Apply today!

Responsibilities:
  • 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.
  • 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.
  • Engage management to escalate issues when needed to assist in issue resolution.
  • Ensure adherence to all applicable SOX coding/reimbursement controls, including, but not limited to Decentral Edit/Denial Processes and Review of Controllable Losses.
  • 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.
  • 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.
  • Perform reimbursement training for new coders.
  • Provide education to staff and physicians to prevent similar edits or conflicting or ambiguous documentation in the future.
  • 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.

Qualifications

  • High school graduate or equivalent. 
  • Graduate of a Certified Professional Coder (CPC) or a certified coding program preferred. 
  • A minimum of two years experience with E/M and surgical CPT/ICD-10 coding and five years payer reimbursement experience related to E/M and surgical coding in a hospital or provider office base setting or combined seven 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-10-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:
Certified Professional Coder (CPC) or eligible preferred. Certified Coding Specialist (CCS) acceptable.

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

Salary Range: $18.24 to $30.32

Union Position: No

Apply Current Employee?

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