Job Title
Purpose: Same responsibilities as a Coder I. Review all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, determine level of acuity, procedure(s) performed, billable supplies and diagnosis to substantiate medical necessity. Review and sequence all codes to maximize reimbursement and address any potential bundling issues. Apply modifiers as needed. LMRP/CCI edit and coding denial resolution.
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.
- Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement.
- 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.
Qualifications:
- High school diploma or equivalent required.
- Completion of an approved, certified medical coding program preferred. Program curriculum should include: Anatomy & Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures.
- Proficient computer skills required; knowledge of Microsoft Excel preferred.
- In lieu of two years of coding experience combined with formal education, a minimum of three years of coding experience or CPC certification is required.
- Experience with professional coding and claim edits preferred.
- Eligible for CPC or CPC specialty certification.
Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran