Coder II, Profee (Coding Denials)

UPMC Corporate Revenue Cycle is hiring a Coder II- Profee to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. This position will be working on Professional (Physician) Coding Denials.  We are looking for Coders who have prior denial experience. 

As the Coder II, you 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 position will also handle 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. 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.