Role Description The role involves managing medical billing and claims with a focus on accuracy and efficiency. - Prepare, review, and submit a high volume of insurance claims daily. - Manage the full billing workflow from claim creation through payment posting and account follow-up. - Submit claims accurately to clearinghouses and ensure timely processing. - Monitor claim status and proactively resolve billing issues. - Investigate, appeal, and resolve claim rejections and denials from start to finish. - Identify billing errors, make necessary corrections, and promptly resubmit claims. - Maintain a strong understanding of Coordination of Benefits (COB) to ensure accurate claim processing. - Apply CPT and HCPCS modifiers correctly based on payer requirements and clinical documentation. - Ensure compliance with insurance payer guidelines across multiple commercial and government payers. - Communicate professionally with healthcare providers regarding documentation and billing questions. - Assist patients or parents/guardians with billing inquiries and account balances. - Collect payments over the phone and establish payment arrangements while providing excellent customer service. Qualifications - Extensive hands-on experience in medical billing with a proven track record of managing high claim volumes. - Strong experience submitting claims to insurance clearinghouses. - Demonstrated success resolving claim rejections and denials through to payment. - Thorough understanding of Coordination of Benefits (COB). - Strong knowledge of CPT/HCPCS coding modifiers and their appropriate application. - Solid understanding of insurance payer guidelines and billing requirements across multiple payers. - Ability to identify billing issues, correct claims, and resubmit them with minimal supervision. - Experience managing the complete medical billing lifecycle from claim submission through payment posting and collections. - Strong analytical, organizational, and problem-solving skills. - Ability to work independently while managing multiple priorities in a fast-paced environment. Preferred Qualifications - Experience using AdvancedMD (strongly preferred). - Experience communicating directly with providers regarding documentation and billing issues. - Experience assisting patients or parents/guardians with billing questions. - Comfortable collecting payments by phone and establishing payment plans. - Experience working with multiple insurance carriers and specialty practices. What We're Looking For The ideal candidate has been deeply involved in every aspect of the medical billing process—not someone whose recent experience has been limited to supervising a billing team. You should have a comprehensive understanding of the entire revenue cycle, be able to troubleshoot billing challenges independently, and consistently keep claims moving efficiently from submission through reimbursement. If you're detail-oriented, proactive, and thrive in a fast-paced billing environment, we'd love to hear from you.

• Responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. • Ensure coding accuracy, regulatory compliance, appropriate reimbursement, and adherence to client-specific coding guidelines, payer requirements, and industry standards. • Review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits. • Accurately assign facility Evaluation and Management (E/M) levels in accordance with client-specific emergency department leveling guidelines and facility charging methodologies, including knowledge of the ACEP tool. • Analyze documentation from nursing staff, physicians, ancillary departments, and diagnostic services to ensure complete code assignment and charge capture. • Apply official coding guidelines, CMS regulations, National Correct Coding Initiative (NCCI) edits, and payer-specific requirements. • Participate in coding quality reviews, audits, educational initiatives, and process improvement activities.

• Complete assigned development tasks using Codex, Claude, or similar AI coding tools • Work independently while following project requirements and coding standards • Ask clarifying questions early to ensure a strong understanding of assigned work • Develop, test, and troubleshoot code as needed • Participate in periodic check-ins to provide progress updates • Maintain clean, organized, and well-documented code • Identify issues and recommend solutions during development • Collaborate with the client to ensure tasks are completed accurately and efficiently

Role Description UPMC Corporate Revenue Cycle is hiring a Coder I- Profee to join our Coding Department! This position will work on Physician Coding for Anesthesia & Pain Management. This will be a work-from-home position working Monday through Friday during business hours. In this role, you will: - Assign ICD and limited CPT codes. - Review the physician documentation to determine the appropriate ICD-10 code and verify the CPT code. - Resolve basic coding edits. - Complete the charging process. - Ensure diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered. - Utilize coding resources (CCI edits, 3M, ICD and CPT Publications) along with any other applicable specialty reference material 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 the 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 complete the coding process accurately. - 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. Qualifications - High school graduate or equivalent. - Graduate of an approved certified coding program preferred with a curriculum that includes Anatomy and Physiology, Medical Terminology, ICD-10-CM and CPT Coding Guidelines and Procedures. - Proficient computer skills with MS Excel knowledge preferred. - In lieu of completed coding externship, 6 months experience. Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.