Job Description

Job Title: Quality Assurance Coding Specialist II
Job ID: 743801
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Assurance
Location: 600 Grant St, Pittsburgh PA 15219


hape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for a Quality Assurance Coding Specialist II to join this community as well.

This position is responsible for quality review/monitoring of Health Plan Coding Specialist Staff/or external coding personnel.  They will perform auditing functions including monitoring, coding of diagnosis, reviewing medical record documentation and discharge summaries to determine if appropriate code was assigned to ensure Health Plan compliance with coding standards. This role provides coding related support to internal Quality Assurance/Fraud and Abuse staff.

This role has the opportunity to work from home.  It is Monday through Friday during daylight hours.  Sound like a fit?  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 HCC auditing experience 
  • Graduate of am 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 Microsoft 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 Tech (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 / hour

Union Position: No

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