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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

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   Current UPMC employees must apply in HR Direct

Certified Coding Specialist I- Health Plan (Remote)


UPMC Health Plan is seeking a Coding Specialist! 

Coders review medical records to identify previously unsubmitted diagnosis codes for HCC Risk Adjustment, thus enhancing and maximizing revenue. In addition at the same time, they identify unsubstantiated codes and remove them to minimize audit risk.

This is a Monday through Friday, Remote role! Apply today!


  • Code Inpatient, SDS and ED charts as necessary.
  • Provide audit findings to coding staff members electronically for coders to review.
  • Develop and present Inpatient/SDS/ED coding seminars for continuing coder education as coding issues are identified from the auditing process.
  • Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG, APC or payment tier under the Prospective Payment system to guarantee accurate reimbursement on UPMC patients.
  • Coordinate continuing education by contacting clinical staff and arranging in-services for the coding staff, as well as keeping current with other education being offered by AHIMA and other professional organizations.
  • Also coordinate re-training of staff as needed due to coding changes/updates, results of audits, etc. Communicate effectively with Patient Business Services, physicians and ancillary departments as necessary to submit accurate and timely billing.
  • Perform internal quality assurance audits on inpatient, SDS, and ED coded records.
  • Discuss audit findings with each coder individually as needed for further clarification.
  • Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure.
  • Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-9-CM and CPT codes including modifiers for correct DRG/APC assignment and accurate reimbursement.
  • Summarizes findings and report these to the Manager.
  • Abstract required medical and demographic information from the medical record and enter the data into the system to ensure accuracy of the database.
  • Responsible for correcting any data found to be in error after reviewing the medical record and comparing with system entries.
  • Submit audit summaries for Inpatient, SDS and ED coding.
  • Submit all educational documents for all patient types to Management.
  • Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology.
  • Utilize computer applications and resources essential to completing the coding process efficiently, such as QuadraMed encoder, Cerner and MARS to ensure timely billing.
  • Submit a monthly auditing/training schedule to the Manager.
  • Perform reviews on Third Party Audit findings/outcomes and prepare report for HIM and Compliance.
  • Submit completed Inpatient, SDS, and ED audit spreadsheets with details for each chart.
  • Review and evaluate focused UPMC DRG or APC medical records for accurate payment prior to billing to ensure that all documented principal and secondary diagnoses, complications and co-morbidities, and procedures are accurately coded.
  • Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care and assign appropriate codes.
  • Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/ or clarification to accurately complete the coding process.
  • Assist with training new staff for inpatient, SDS and ED coding.
  • Complete work assignments in a timely manner.
  • Review coding for accuracy and completeness prior to submission to billing.
  • Identify areas of coding weakness and develop training plans to address these.
  • Assist with identifying continuing education needs and opportunities.



  • Graduate of an AHIMA or AAPC Certified Coding Program that includes Anatomy & Physiology, Pharmacology and Medical Terminology.
    • Example: Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
  • Associates Degree from an accredited Health Information Management program preferred.
  • Five (5) years of total experience.

Licensure, Certifications, and Clearances:

  • Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
  • Act 34

  • 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