Senior Professional Fee Medical Coder

Employment Duration: 3 months

Department: Faculty Practice Revenue Management Operations (FPRMO)

The Patient Record Abstractor fulfills a role as a Medical Coder for UCSF’s physician practices. The position reviews patient records, discharge summaries, operative reports, and other clinical documentation to assign standardized codes for diagnoses, procedures, and services.

The role applies national and international coding classifications to ensure records reflect the care delivered, supporting accurate reimbursement and reliable clinical data. It requires knowledge of Current Procedural Terminology (CPT), International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), and Healthcare Common Procedure Coding System (HCPCS).

The position operates within a healthcare records or billing team and requires close liaison with clinicians, clinical coders, and administrative staff to resolve documentation queries. The coder must maintain currency with coding updates, compliance requirements, and professional standards and participate in regular audits to monitor coding quality.

Expectations include timely processing of case volumes while maintaining high accuracy, adherence to confidentiality and information governance standards, and contribution to process improvements that enhance data quality and coding efficiency.

Key Responsibilities:

• Work in complex work queues daily as defined by UCSF Leadership.
• Work in moderate and simple work queues as needed.
• Work RFI and edit work queues as needed.
• Maintain or exceed a 95% accuracy rate.
• Maintain productivity standards as defined by UCSF Leadership.
• Work proactively with divisions in areas of specialization to assure appropriate revenue cycle practices and compliance with internal and external regulations.
• Code complex procedures/accounts requiring advanced expertise in charge capture, workflow, hospital operations, authorizations, and revenue cycle.
• Resolve Claims Manager and Epic edits to ensure correct coding of services provided, including review of documentation for correct coding and E/M leveling, diagnosis coding, bundling issues, modifier usage, and related matters.
• Apply dashboards and processes for continuous analysis of complex revenue cycle functions of diverse scope.
• Audit data input to support revenue cycle management.
• Complete other coding working reports, reconcile charge lists, create charge sessions, update DEPs, and follow up on credentialing requests.
• Serve as the lead on applicable billing, coding, and revenue cycle regulations and effectively communicate these regulations to all levels of faculty, management, and staff.
• Demonstrate the ability to teach and train the team in designated areas of specialty/subspecialty expertise.
• Stay current on upcoming coding audits, regulations, trends, OIG initiatives, and applicable carrier initiatives as they pertain to the subspecialties led by the coder to provide pertinent information and tools to the team, minimize risk, and enhance education efforts.
• Proactively research and review coding directives by the OIG, CMS, the current intermediary, and national and local insurance carriers.
• Analyze complex coding data and identify trends in revenue cycle operations.
• Summarize data and present reports to leadership.

N/A

Required Qualifications:

• 5+ years of revenue cycle professional fee coding experience or equivalent experience/training.
• Strong communication skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner.
• Ability to prepare compelling and informative reports and presentations.
• Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.
• Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
• Must be able to pass all classes related to UCSF Medical Center’s computer systems as well as related UCSF coding and billing applications. May include off-site billing systems from partner hospitals.
• Demonstrated advanced knowledge of medical terminology, CPT, ICD-10 coding conventions, and clinical documentation requirements.
• Prior experience in a healthcare-related setting.
• Knowledge of Federal, State, and Commercial carriers’ coding and billing standards.
• Certified Professional Coder (CPC), Certified Coding Specialist—Physician Based (CCS-P), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or licensure equivalent to be evaluated by FPRMO management.
• Secondary coding certification such as Certified Interventional Radiology Coder (CIRC), Certified Emergency Department Coder (CEDC), etc.

Preferred Qualifications:

• Bachelor’s degree in a related area and/or equivalent experience/training.
• Prior experience in an Academic Medical Center.
• Prior experience with Epic.
• Prior experience with Encoder Pro.