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Novus Group

Coder II - Profee


Clinical Data Management




Pittsburgh, Pennsylvania, United States

Pay rate up to $23.00 per hour ($47,840 annually) based on experience
  • Full-time, Direct Hire position
  • On-site, in person – Pittsburgh, PA 15203
  • Work Schedule: Monday through Friday – Eastern Time Zone standard daylight business hours
Novus Group is your advocate to access DIRECT HIRE positions with a multibillion-dollar health enterprise that has over 100,000 employees, hospitals, corporate offices, a multi-million-member health insurance division and much, much more! Ranked consistently within the top hospitals in America, the Company is known nationally, internationally, and globally. The Company offers many high value benefits: Competitive Pay, Outstanding Benefits (healthcare, vision, dental, life insurance, paid parental leave, generous PTO and paid holiday time, tuition assistance, help with work/life balance with options for child/pet care, help with elderly loved ones, and many more employee support programs to help you succeed in all aspects of your work and personal life!!

We seek a Coder II - Profee possessing the following skills, experience and/or certification(s):

MINIMUM Qualifications:
  • High school graduate or equivalent - REQUIRED
  • Graduate of an approved certified coding program preferred
  • Approved coding program curriculum includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures
  • Proficient computer skills with MS excel knowledge
  • Must possess at least one (1) of the following requirements:
    • 2 years of coding experience and graduated from approved certified coding program, or
    • a minimum of 3 years’ coding experience, or
    • current/valid CPC certification
The Coder II - Profee will review all pertinent physician, nursing and ancillary documentation in the medical record. Depending on type of service and place of service, determine level of acuity, procedure(s) performed, billable supplies and diagnosis to substantiate medical necessity. Review and sequence all codes to maximize reimbursement and address any potential bundling issues. Apply modifiers as needed. LMRP/CCI edit and coding denial resolution.

  • Utilize computer applications and resources essential to completing the coding process efficiently.
  • Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff.
  • Refer problem accounts to appropriate coding or management personnel for resolution.
  • Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process.
  • Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement.
  • Make forward progress within the 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.
  • 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.) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
  • Adhere to internal department 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.
  • 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.