Coder II, Professional (ENT Coding) at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

11 May, 26

Salary

0.0

Posted On

10 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

ENT Surgical Coding, Physician Documentation Review, Diagnosis Coding, Procedure Coding, Medical Necessity Substantiation, Code Sequencing, Modifier Application, LMRP/CCI Edit Resolution, Coding Denial Resolution, Productivity Standards, Physician Query Formulation, ICD Coding, CPT Coding, Coding Guidelines Adherence, Accuracy Standards, MS Excel Knowledge

Industry

Hospitals and Health Care

Description

UPMC Corporate Revenue Cycle is hiring a Coder II- Profee! This position will be a work-from-home position working Monday through Friday during business hours. This role will have the same responsibilities as a Coder I. The position will review all pertinent physician, nursing, and ancillary documentation. Depending on the type of service and place of service, you will determine the level of acuity, procedure(s) performed, billable supplies, and diagnosis to substantiate medical necessity. As well as review and sequence all codes to maximize reimbursement and address any potential bundling issues. The Coder II will apply modifiers as needed. The position will also handle LMRP/CCI edit and coding denial resolution. We are looking for coders with prior experience in ENT surgical coding to join the team. If you are ready to take the next step in your coding career, look no further! Responsibilities: Utilize computer applications and resources essential to completing the coding process efficiently. Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff. Refer problem accounts to appropriate coding or management personnel for resolution. 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. Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement. Make forward progress within the 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 management staff. Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Adhere to internal department and system-wide competencies, behaviors, policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by reviewing updated CPT assistant guidelines and updated coding clinics. Complete work assignments in a timely manner and understand the workflow of the department. Maintain daily productivity statistics and submit a weekly productivity sheet to management. High school graduate or equivalent. Graduate of an approved certified coding program preferred. Curriculum includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures. Proficient computer skills with MS excel knowledge preferred. In lieu of 2 years of coding experience with schooling, a minimum of 3 years experience or CPC certification required. Licensure, Certifications, and Clearances: Eligible for CPC or CPC specialty certification. Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The Coder II will review physician, nursing, and ancillary documentation to determine acuity, procedures, supplies, and diagnoses to substantiate medical necessity, sequencing codes to maximize reimbursement and resolve denials. Responsibilities also include utilizing coding guidelines to assign appropriate ICD and CPT codes, meeting productivity standards, and formulating physician queries for incomplete documentation.