Job Description

Job Title: Coding/Reimbursement Specialist
Job ID: 73313001
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Rev Cyc Coding
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description

Purpose:
Use your coding and reimbursement knowledge in this great opportunity with UPMC!  The Coding/Reimbursement Specialist ensures that accurate claim submission and reimbursement has been met for all account types by identifying ICD-10, CPT and modifier usage thorough review of the medical record, which includes understanding anatomy, physiology, medical terminology, and disease processes, as well as payer reimbursement guidelines.  This role is based at the Quantum building with potential to work from home.  It is a full time Monday through Friday opportunity during daylight hours.

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

Qualifications

  • High school graduate or equivalent. 
  • Graduate of a 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:
CPC or eligible preferred. CCS acceptable.


UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $18.79 to $31.23 / hour

Union Position: No

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