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Three Rivers Orthopedics is seeking a Certified Specialty Coder to support 11 orthopedic surgeons specializing in areas including spine and foot/ankle at 200 Delafield Road, Suite 1040, Pittsburgh, PA 15215. This full-time position runs Monday-Friday, 8:00 AM-4:30 PM, with the potential for work-from-home flexibility after training

Responsibilities:

+ 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.

+ Monitor billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.

+ Perform all coding functions, based on staffing needs and/or department requirements.

+ Refer problem accounts to appropriate coding or management personnel for resolution.

+ Maintain daily productivity statistics and submits 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. Balance daily charges to data entry, forwarding results to departmental designee.

+ Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding, or hospital specific acuity level module as needed.

+ Assess current CPT guidelines as well as other applicable payer coding policy changes.

+ Lead, participate in and/or assist with departmental coding audits.

+ Identify incomplete documentation in the medical record and formulates 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.

+ Incorporate into departmental procedures and communicates changes to coders and providers.

+ Adhere to internal department policies and procedures to ensure efficient work processes.

+ Maintain required CPC or CSS-P certification and continuing education by attending seminars, reviewing updated CPT Assistant guidelines and updated coding clinics.

+ Adhere to department time goal for final coding entry to prevent charge lags.

+ If applicable, abstract required medical and demographic information from the medical record and enters the data into the appropriate information system to ensure accuracy of the database. Responsible for correcting any data to be in error after reviewing the medical record and comparing with system entries.

+ Progress within the training period toward meeting departmental coding accuracy standards within the first year of employment by assigning correct principal diagnosis/procedure, complications and co-morbidities, and secondary diagnoses as reviewed by the designated trainer and/or the DRG Specialist. Coder should meet appropriate coding productivity standards within the time frame established by management staff.

+ Advise and instruct providers regarding billing and documentation policies, procedures, and regulations; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.

+ Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.

+ Demonstrate proficiency on billing system functionality as related to claim edit/charge review queues, as well as reimbursement denials.

+ Complete work assignments in a timely manner and understands the workflow of the department.

+ Train all new Coders to observe established coding guidelines and to utilize the appropriate billing system.

+ Investigate and resolve reimbursement issues, including denials, in a timely manner per department standards.

+ Analyze and interpret patient medical records within an area of medical/clinical specialty in order to determine amount and nature of billable services.

+ 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.

+ Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.

+ High school diploma or GED is required.

+ Graduation from an approved Health Record Administration or Accredited Medical Record Technician program (RHIA/RHIT or eligible) or a certified coding program preferred.

+ 3 years of coding experience in the applicable medical specialty is required.

+ Advanced knowledge of medical coding and billing systems and regulatory requirements is required.

+ Ability to provide training, guidance, and operational support to lower level staff within area of specialty is required.

+ Experience and knowledge of accurate DRG and APC assignment is essential.

+ Ability to problem solve and be knowledgeable in advanced medical terminology, human anatomy/physiology, pharmacology, pathology and the principles of ICD-9-CM and CPT Classification Systems and DSM IV, if applicable.

+ Proficient computer skills, including working knowledge of MS Excel and MS Access, is preferred.Licensure, Certifications, and Clearances:

+ Certified Professional Coder (CPC)

+ Act 34UPMC is an Equal Opportunity Employer/Disability/Veteran