[Hiring] Certified Coding Specialist @UPMC

Role Description

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.
• Conducting audits to ensure accuracy in code and charge selection.
• Supporting internal and external audit reviews—including RAC-related audits.
• Approving 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 include:

• Adhering to internal system-wide policies, competencies, behaviors, and procedures to ensure efficient work processes.
• Actively participating in periodic coding meetings and sharing ideas and suggestions for operational improvements.
• Utilizing 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.
• Coding all diagnoses and procedures by assigning and verifying the proper ICD and CPT codes.
• Assigning the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding.
• Identifying incomplete documentation in the medical record and formulating a physician query to obtain missing documentation and/or clarification to accurately complete the coding process.
• Investigating and resolving reimbursement issues, including denials, in a timely manner and demonstrating proficiency on the billing system.
• Monitoring billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling.
• Preparing periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
• Advising and instructing coders/providers regarding billing and documentation policies, procedures, and regulations.
• Interacting with providers regarding conflicting, ambiguous, or non-specific medical documentation to obtain clarification.
• Referring problem accounts to appropriate coding or management personnel for resolution.
• Working with department management on coding interface, development, enhancements, and changes, as well as implementation of those functions.

Qualifications

• High school graduate or equivalent.
• Graduate of an approved certified coding program preferred.
• Proficient computer skills with MS Excel knowledge preferred.
• 5 years surgical coding experience (includes anesthesia coding) OR advanced E/M coding experience.
• Professional coding experience is preferred.

Requirements

• High school graduate or equivalent.
• Graduate of an approved certified coding program preferred.
• Proficient computer skills with MS Excel knowledge preferred.
• 5 years surgical coding experience (includes anesthesia coding) or advanced E/M coding experience.
• 2 years training or supervisory experience required.
• 7-10 years of professional coding is preferred.

Licensure, Certifications, and Clearances

• CPC or Certified Coding Specialist (CCS) specialty certification required.
• Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT).

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.