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Certified Coding QA Specialist

  • Job ID: 449808222
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Revenue Cycle
  • Department: Rev Cyc Coding
  • Location: , Work From Home
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

UPMC is hiring a Certified Coding QA Specialist to join our team!  This role will work Monday through Friday and can start between the hours of 6:00 AM to 7:30 AM.   This opportunity will be a remote position and work from home.

This role will utilize advanced knowledge of specialty coding to perform quality assurance reviews and analyze patient medical records which may include inpatient, outpatient, rehabilitation, physician office for both UPMC and non-UPMC facilities.  The position responsibilities include the validation and review of specified medical diagnoses and/or clinical procedures through the utilization of analytical software for claim and insurance review.

Do you have prior auditing and coding experience?  If so, this could be the next step in your career!  Apply today!

Responsibilities:

 

  • Maintains daily productivity statistics and submits a weekly productivity sheet to management clearly indicating the number of hours worked, number of charts per hour and the number of minutes/hour spent on non-coding audit tasks.
  • Investigates and responds to payment and/or DRG or APC assignment denials by Workers Compensation, Quality Insights, and other insurers.Investigates and responds to authorization denials when a discrepancy exists between technican and professional coding.
  • Investigates reports run by the management staff that identify potential coding inaccuracies based on charging and coding comparisons.
  • For hospital services, reviews DRG and APC assignment to ensure that all documented principal and secondary diagnoses, incluidng all complications and co morbidities, and procedures are accurately coded and sequenced according to coding and compliance guidelines.For professional services, reviews the CPT code assignment, modifier assignment and ICD-CM assignment, including all complications and co morbidities, and procedures are sequenced according to coding and compliance guidelines.
  • Completes audits in a timely manner and understands the workflow of the healthcare delivery system.
  • Maintains required continuing education units by attending seminars, reviewing updated CPT guidelines, updated coding clinics, compliance watch and other publications to ensure compliance with federal and state guidelines.
  • Tracks and reports quality statistics with the analytical software system and reports this information at the conclusion of the coding review.
  • Utilizes computer applications and resources essential for completing the audits efficiently.
  • Adheres to department time goal for all audits performed.
  • Presents indications, utilizing clinical judgment, of a diagnosis that is not documented in the medical record in the form of a written recommendation. Track the incidence and frequency of such occurrences for educational purposes. Identifies and reports trends to their supervisor.
  • Participates in monthly coding quality assurance meetings. Provide management with updates on any coding issues and educational opportunities based on audit findings.
  • Review for undocumented diagnoses that are supported within the body of the medical record by clinical indicators.
  • Reviews billing data entered into MEDIPAC from the 3M encoder to ensure completeness and accuracy on targeted financial classes and focus review charts.
  • Refers quality concerns to appropriate member of the management team.
  • Adheres to internal department policies and procedures to ensure efficient work processes.

 

Qualifications

  • Graduate of an approved Health Records Administration program or Accredited Record Technician (RHIA/RHIT) or a certified coding certificate.
  • Minimum of three years of coding experience.
  • For hospital reviews, thorough working knowledge of the Prospective Payment System and Diagnostic Related Group (DRG) and Ambulatory Payment Classification (APC) selection or specific knowledge as a consultant in Medical Record coding is required.
  • Knowledge of computer technology, quality assurance activities, Quality Insights/Utilization review background is highly desirable.
  • The ability to communicate with staff, physicians, healthcare providers, and other health care system personnel in a professional and diplomatic manner is necessary.


Licensure, Certifications, and Clearances:

  • RHIA, RHIT, Certified coding certificate or eligible is required.
  • Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct