Responsible for quality review/monitoring of Ovation Revenue Cycle Services coding or clients coding personnel. Performs auditing functions including monitoring, coding of diagnosis, reviewing medical record documentation and discharge summaries to determine if appropriate code was assigned to ensure compliance with coding standards.
- Audit medical record documentation to identify undercoded and upcoded services
- Communicate effectively with internal staff
- Compile and report statistical data to internal staff
- Completion of special projects including claims and/or coding related audit support
- Ensures strict confidentiality of all records
- Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology
- Prepares detailed audit assessments and reports with recommendations and shares to appropriate internal and external customers in a timely manner
- Provide assistance to other departments as requested.
- Provides a second level review of coding to ensure compliance with legal procedural policies and to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices
- Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure.
- Under direct supervision reviews the coding diagnoses and CPT codes for multi-specialty coding or SDS coding are assigned correctly and if all diagnoses and procedures are identified.
- Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-10-CM and CPT codes were assigned including modifiers for APC assignment and accurate reimbursement
- Under general supervision reviews the coding of diagnoses and E/M levels verifying the proper codes were assigned
- May create and present education and interact with client and providers
Bachelor's Degree or equivalent education/experience. 5 years of relevant coding or coding audit experience. Coding certifications accepted: CCS, CPC, CPC-A, COC, CIC, CPC-H, CCS-P, RHIA, RHIT Graduate of an approved Health Record Administration, HIM or Accredited Medical Record Technician program (RHIA/RHIT or eligible) or a certified coding program. Extensive knowledge of ICD-10 and/or CPT classifications and coding of diagnoses and procedures is required. In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required. The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential. Excellent written and verbal communication skills are essential. Proficiency in computer skills required for coding. Detail oriented individual with excellent organizational skills. High degree of oral and written communication skills. Proficiency in MS Office/PC skills. Traveling may be required as necessary.
Licensure, Certifications, and Clearances:
CCS, CPC, CPC-A, COC, CIC, CPC-H, CCS-P, RHIA, RHIT required
- Certification in Infection Control or Certified Coding Specialist or Certified Professional Coder or Registered Health Information Administrator or Registered Health Information Technician
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities