• Coder I - Profee

    UPMC (Pittsburgh, PA)


    Purpose:Assign ICD and limited CPT codes for professional (Profee) services, primarily in Neurosurgery and Neurology. The coder reviews physician documentation to determine the appropriate ICD-9 code and primarily verifies CPT codes, but in some cases assigns basic CPT codes. Responsibilities include resolving basic coding edits, completing the charging process, and ensuring diagnosis codes meet local medical necessity guidelines for ancillary tests ordered-requiring knowledge of billing and coding guidelines. Utilize coding resources such as CCI edits, 3M, ICD and CPT publications, and other applicable specialty reference materials to ensure accurate coding.

    Responsibilities:

    + Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD and CPT for all records to ensure accurate reimbursement. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.

    + 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.

    + 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.

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

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

    + Meet and maintain charge lag and coding productivity standards within the time frame established by management staff.

    + Adhere to internal 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.

    + Make forward progress within the training 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.

     

    a {

     

    text-decoration: none;

     

    color: #464feb;

     

    }

     

    tr th, tr td {

     

    border: 1px solid #e6e6e6;

     

    }

     

    tr th {

     

    background-color: #f5f5f5;

     

    }

    Required Qualifications

    + High school diploma or equivalent.

    + In lieu of a completed coding externship, 6 months of coding experience is required.

    + Proficient computer skills; MS Excel knowledge preferred.

    Preferred Qualifications

    + Graduate of an approved certified coding program (curriculum should include Anatomy & Physiology, Medical Terminology, ICD-9-CM, and CPT Coding Guidelines and Procedures).

    + Epic experience preferred (not required).

    + E/M coding experience preferred (not required).

    Key Skills

    + Strong attention to detail and accuracy.

    + Ability to work independently and as part of a team.

    + Excellent communication skills.

    Licensure, Certifications, and Clearances:

    + Act 34

     

    UPMC is an Equal Opportunity Employer/Disability/Veteran