Certified Coding Specialist - Profee

UPMC is currently hiring multiple Certified Coding Specialists to join the Physician Revenue Cycle Enhancement team. This position offers the flexibility to work remotely.

In this role, you will be responsible for reviewing medical charts to identify opportunities for process improvement. You will conduct audits to ensure accuracy in code and charge selection, support internal and external audit reviews—including RAC-related audits—and approve account adjustments as appropriate.

We’re seeking candidates who are passionate about driving process enhancements and comfortable collaborating directly with physicians across the UPMC system.

The final candidate will be selected for a job title within the career ladder that reflects the level of education, experience, and manager discretion at the time of offer.

Responsibilities:

• Adhere to internal system-wide policies, competencies, behaviors and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares 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.
• 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 on billing system.
• 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; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.