Job Description

Job Title: UM Coding & Review Specialist - Home Health
Job ID: 66059780
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Department: Utilization Review North
Location: 300 Northepoint Circle, Seven Fields PA 16046


To provide support involving medical data, information technology, electronic health records and health information management to the utilization management department.

  • Expand knowledge and expertise through educational resources and literature review
  • Demonstrate support of the agency's Mission, Principles, and Values, Ethics & Standards of Behavior
  • Performs in accordance with system wide competencies/behaviors
  • Demonstrate ability to effectively communicate with all members of the healthcare team
  • Maintain and protect patient and Agency confidentiality
  • Promote personal and co-worker safety during work duties
  • Educate and require adherence to performance improvement processes and initiatives
  • Meet established productivity standards
  • Confirm OASIS scoring and/or documentation is reflected in projected visit pattern; identify any variance to established parameters and consult accordingly with Utilization Manager
  • Achieve and maintain ICD 10 coding expertise (as evidenced by corresponding certification) and function as a resource for clinicians with coding questions
  • Demonstrate proficiency in Medicare, Medicaid, and Commercial insurance regulations
  • Responsible for processing of Plans of Treatment in conjunction with clerical personnel
  • Generate specific utilization reports as requested
  • Responsible for assuring an efficient and customer friendly communication with internal and external customers
  • Responsible for overall review and processing of assigned Home Health clinical records at specific time frames including start of care, resumption of care, re-certification and ongoing as required
  • Examine OASIS, identify discrepancies utilizing SHP software, validate accuracy and ensure comprehensive completion of the assessment
  • Consult with appropriate clinician as necessary, in conjunction with Utilization Manager
  • Validate accuracy of diagnosis, ensure appropriate ranking of diagnosis and assign corresponding ICD 10 codes
  • Consult with Clinical UM Reviewer/UM Supervisor with admission identified as high skill level and/or complex care


  • High School graduate required
  • LPN or Associates Degree is required or program enrolled 
  • Minimum two years related healthcare work experience
Computerization skills:  
  • Demonstrate ability to perform computer skills in specialized computer application(s) as needed
Special Requirements: 
  • Related course work in medical terminology or demonstrates a strong working knowledge of medical terminology
  • Working Knowledge of ICD 10 Coding
  • Working Knowledge of OASIS
  • Demonstrates high level critical thinking skills
  • Position requires travel to various office sites, valid PA drivers' license and proof of auto liability required

Licensure, Certifications, and Clearances:
Certification of ICD 10 Coding obtain within one year of hire.Certification of OASIS obtain within one year of hire. LPN if applicable.

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

Salary Range: $15.58 to $24.54 / hour

Union Position: No

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