"Alerted.org

UPMC Health Plan has an exciting opportunity for a Certified Coding Specialist I position in the Medicare HCC department. This is a full time position working Monday through Friday daylight hours. This is a remote position.

Ability to code using ICD-10-CM and appropriately assigning diagnosis and procedure codes after reviewing all documentation available. Performs audits to determine accuracy of code selection. Responsible for validating diagnoses submitted via claims to the Health Plan by reviewing inpatient, outpatient, and provider office documentation.

Responsibilities:

+ Code Inpatient, Outpatient, physician, and ED charts as necessary.

+ Assign Risk Adjustment HCC diagnoses by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology, and pathology.

+ Review the discharge summary, history and physical, physician progress notes, consultation reports, operative records, emergency room record to accurately assign a diagnosis and / or procedure.

+ Review appropriate documents to accurately assign a Risk Adjustment HCC diagnosis.

+ Review coding for accuracy and completeness prior to submission.

+ Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-10-CM and CPT codes.

+ Utilize computer applications and resources essential to completing the coding process efficiently.

+ Responsible for correcting any data found to be in error after reviewing the medical record and comparing with system entries.

+ Complete work assignments in a timely manner.

+ Meet coding accuracy standards of 95% as well as coding productivity standards.

+ Complete coder productivity and time log daily.

+ 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.

+ Performs in accordance with system-wide competencies/behaviors.

+ Performs other duties as assigned.

+ Graduate of an AHIMA or AAPC Certified Coding Program that includes Anatomy & Physiology, Pharmacology and Medical Terminology.

+ 5 years of total experience.

+ Knowledge of Microsoft Office. **Licensure, Certifications, and Clearances:** Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) required.

+ Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC)

UPMC is an Equal Opportunity Employer/Disability/Veteran