Certified Professional Coder - Women's Health

UPMC is hiring a full-time Certified Professional Coder to support their Women's Health Departments! This position is a remote position, but will be required to work onsite at an office location during our training period. Candidates must be located within a 60-mile radius of Pittsburgh or willing to relocate to the area.

Our Womens Health decentralized coding team provides specialized coding support across multiple subspecialties, ensuring accurate and compliant claim submission for a diverse range of services. The team is experienced in handling complex subspecialty claims and coding scenarios unique to the Womens Health service line, including OB/GYN, Uro-gynecology, and Minimally Invasive Surgeries. With a focus on quality, collaboration, and operational efficiency, the team supports timely charge capture and revenue integrity across multiple practice locations across Western PA.

The Certified Professional Coder supports Womens Health services by reviewing and releasing charges daily and accurately coding office visits and complex surgical services. The role includes querying providers for complete documentation, resolving denials through corrections and appeals, and ensuring timely claim follow-up. The coder also serves as a resource for providers, patients, and payors while maintaining compliance and supporting revenue integrity within a subspecialty Womens Health environment.

This position will work Monday through Friday, daylight hours, with no evenings, weekends, or holidays required! Previous experience in coding surgical cases is preferred.

Responsibilities:

• Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification and provide education to physicians to accurately complete the coding process.
• Refer problem accounts to appropriate coding or management personnel for resolution.
• 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 staff.
• Provides training on code selection for new and existing staff.
• Investigate and resolve reimbursement issues, including denials, in a timely manner per department standards.
• Responsible for assigning PQRS codes and assists in the development of templates and processes to obtain the appropriate documentation.
• Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc). Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding.
• 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.
• Be a resource to other coding staff.
• Utilize computer applications and resources essential to completing the coding process efficiently.
• 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.
• Work with department management on coding interface, development, enhancements and changes, as well as implementation of those functions.
• Lead, participate in and/or assist with departmental coding audits.