UPMC
Coding/Reimbursement Specialist Homebased Remote jobs We’re looking for a Coding Reimbursement Specialist to join our team at UPMC Corporate Revenue Cycle! This position will be available Monday through Friday during normal business hours. The job will be completely remote! Homebased Remote jobs
The position ensures accurate claim submission and reimbursement for all account types by identifying ICD-9, CPT, and modifier usage, as well as payer reimbursement guidelines, through a thorough review of the medical record, which includes understanding anatomy, physiology, medical terminology, and disease processes.
- Job ID: 333549306
- Status: Full-Time
- Regular/Temporary: Regular
- Hours:
- Shift: Day Job
- Facility: Corporate Revenue Cycle
- Department: Rev Cyc Coding
- Location: Work From Home
- Union Position: No
- Salary Range: $20 to $33.22 / hour
Duties and responsibilities
- Monitor and resolve coding modifications and denials as soon as possible to guarantee optimal reimbursement while adhering to major payer restrictions banning unbundling, and handle issues with unlisted procedures or procedures with the -22 modifier to assure increased compensation.
- Investigate payers’ coding and reimbursement policies for new and/or existing services in collaboration with providers and coders.
- To maintain efficient work processes, adhere to internal and system-wide competencies/behaviors, policies, and procedures. Participate actively in coding meetings on a regular basis and contribute thoughts and proposals for operational improvements.
- To maximize reimbursement, contact payer representatives to explore policy exceptions and file appeals. Any appropriate costs should incorporated into the department’s daily process flow.
- Demonstrate computer skills in using multiple software tools and resources, such as Epic (Resolute), payer reimbursement portals, and electronic medical record repositories, to efficiently complete coding, edit, and denial processes.
- Ensure that any applicable SOX coding/reimbursement controls, such as Decentral Edit/Denial Processes and Review of Controllable Losses, are followed.
- Review appropriate payer coding policy, submit appeals in accordance with guidelines, update bulletins, and inform coding employees and providers of any changes. Any essential changes should incorporated into the department’s daily process flow.
- Also, Assist in the settlement of difficulties by engaging management to escalate issues as needed.
- Develop and maintain full awareness of the department’s entire workflow, including all functions and the importance of completing each task on time.
- Within the first year of employment, make progress toward fulfilling the departments’ coding accuracy standards during the training term.
- Also, Within the time range set by the management team, meet adequate coding productivity criteria.
- Staff and physicians should be educated to avoid future modifications, as well as contradicting or unclear paperwork.
- Moreover, New coders should be given reimbursement training.
Qualification
- A high school diploma or its equivalent required.
- Also, A CPC or a certified coding program graduate is preferred.
- A minimum of two years of E/M and surgical CPT/ICD9 coding experience in a hospital or provider office context, as well as five years of payer reimbursement experience related to E/M and surgical coding, or a combined seven years of experience.
- Modifiers and their impact on payer reimbursement must be familiar.
- Medical terminology, human anatomy/physiology, pharmacology, pathology, and the principles of the ICD-9-CM and CPT Classification Systems are required, as well as the ability to problem-solve effectively.
Licensure, Certifications, and Clearances:
CPC or eligible preferred. CCS acceptable
UPMC is an Equal Opportunity Employer/Disability/Veteran
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