Certified Coding Specialist I-Profee

at  UPMC

UPMC is seeking to hire a Certified Coding Specialist I, with at least five years of experience in surgical coding, to join our Coding Department. This is a work-from-home position, working Monday through Friday during standard business hours.
As a Certified Coding Specialist I, you will have the same responsibilities as a Certified Specialty Coder plus provide training on code selection for new and existing staff. You will perform audits to determine code and charge selection accuracy as well as summarize coder accuracy for Managers. Identify topics for training and education, research topics and assist with the assembly of training materials and CDI process. Assist with audit reviews including all internal, external, and RAC associated coding audits. Supervise on-site staff. Review and approve adjustments to accounts. Responsible for Kronos approval and sign-off.

• Adhere to internal system-wide policies, competencies, behaviors, and procedures to ensure an efficient work process. Actively participate in periodic coding meetings and share ideas and suggestions for operational improvements.
• Utilize advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third-party payer requirements.
• Supervise staff including assignments and Kronos approval and signoff. Also, assist with recruitment.
• Code all diagnoses and procedures by assigning and verifying the proper ICD and CPT codes. Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding.
• 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.
• Investigate and resolve reimbursement issues, including denials, in a timely manner and demonstrate proficiency in using billing systems.
• Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling. Prepare periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
• Advise and instruct coders/providers regarding billing and documentation policies, procedures, and regulations; interact with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
• Progress within the training period toward meeting departmental coding accuracy standards within the first year of employment by assigning correct principal diagnosis/procedure, complications and co-morbidities, and secondary diagnoses as reviewed by the designated trainer. The coder should meet appropriate coding productivity standards within the time frame established by management staff.
• Train all new Coders to observe established coding guidelines and to utilize the appropriate billing system.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• Lead, participate and/or assist with departmental coding audits.
• Work with department management on coding interface, development, enhancements, and changes, as well as implementation of those functions.
• High school graduate or equivalent.
• 5 years of surgical coding experience (includes anesthesia coding) OR advanced E/M coding experience.
• Graduate of an approved certified coding program preferred.
• Proficient computer skills with MS excel knowledge preferred.