Coder II - Technical (Outpatient Coding)

UPMC Corporate Revenue Cycle is hiring a Coder II- Technical to join our Coding team! This position will be a work-from-home position working Monday through Friday during business hours.

In this role, you will be handling outpatient coding which will mainly include Same Day Surgeries and Special Procedure Coding. We are looking for individuals with at least two years of hospital coding and working knowledge of ICD-10-CM diagnosis coding as well as CPT, HCPCS and Modifiers.

Responsibilities:

• Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD-9-CM, CPT and DSM IV codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc). Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding, or hospital specific acuity level module as needed.

• Adhere to internal department 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 attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics.

• Make forward progress within the training period toward meeting coding accuracy standards of 98% within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff.

• Code all diagnoses and procedures by assigning and verifying the proper ICD-9-CM and CPT codes (DSM IV if applicable). Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding.

• Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems (Medipac/SMS/Meditech), encoders and electronic medical record repositories. If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database. Correct any data to be in error after reviewing the medical record and comparing with system entries.

• Refer problem accounts to appropriate coding or management personnel for resolution

• 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 clearly indicating the number of hours worked, the number of coding hours, the number of average charts per hour, and number of minutes/hours spent on non-coding tasks.

• Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care and assign appropriate codes. Review appropriate documents in the patients' charts to accurately assign a diagnosis and/or procedure. Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG/APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients.

• 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. Consult with DRG Specialist when applicable during query process.

• High School or GED equivalent.

• Two years of hospital coding experience.

• Completed an AHIMA or AACP-certified Coding program or certificate, Bidwell Training School or equivalent program.

• Curriculum includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures.

• Outpatient: pharmacology is taught on the job during training; pathophysiology not required.

• Inpatient: Pharmacology & pathophysiology coursework required.

Licensure, Certifications, and Clearances:

• Eligible for RHIA, RHIT, CCS

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran