Senior Professional Fee Coding Specialist

Location: Fully-Remote

Employment Duration: 3 months 

Patient Records Abstractor fulfills a role as a Medical Coder for UCSF’s physician practices. They review patient records, discharge summaries, operative reports, and other clinical documentation to assign standardized codes for diagnoses, procedures, and services. They apply national and international coding classifications to ensure records reflect the care delivered, supporting accurate reimbursement and reliable clinical data. They have knowledge of Current Procedural Terminology (CPT), International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), and Healthcare Common Procedural Coding System (HCPCS). The role operates within a healthcare records or billing team and requires close liaison with clinicians, clinical coders, and administrative staff to resolve documentation queries. Coders must maintain currency with coding updates, compliance requirements, and professional standards, participate in regular audits to monitor coding quality, process assigned case volumes in a timely manner while maintaining high accuracy, adhere to confidentiality and information governance standards, and contribute to process improvements that enhance data quality and coding efficiency.

Department Overview:

The Faculty Practice Revenue Management Operations (FPRMO) department is responsible for physician-based coding for UCSF faculty. The team ensures accurate code assignment for professional services delivered across UCSF locations, affiliated community hospitals, off-license practices, and ambulatory clinics.

FPRMO supports a diverse group of providers, including physicians, nurse practitioners, and advanced practice providers, across a wide spectrum of specialties within an academic medical center environment. These specialties include Neurosurgery, Cardiovascular Services, OB/GYN, Gender Reassignment, Rheumatology, and Plastic Surgery.

FPRMO plays a critical role in the revenue cycle by delivering precise and compliant coding for approximately 1.6 million patient encounters annually, supporting both regulatory requirements and optimal reimbursement.

Key Responsibilities:

• Review and code complex patient encounters in assigned work queues.
• Work in moderate and simple work queues as needed.
• Process RFI and edit work queues as needed.
• Maintain a minimum 95% coding accuracy rate.
• Meet productivity standards established by UCSF leadership.
• Collaborate proactively with clinical divisions to support compliant revenue cycle practices.
• Code complex procedures and accounts requiring advanced expertise in charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
• Resolve Claims Manager and Epic edits through documentation review, including evaluation and management (E/M) leveling, diagnosis coding, bundling issues, modifier usage, and related coding requirements.
• Use dashboards and reporting processes to analyze complex revenue cycle functions and audit data supporting revenue cycle management.
• Complete coding-related work reports, reconcile charge lists, create charge sessions, update department information, and follow up on credentialing requests.
• Serve as a lead resource on applicable billing, coding, and revenue cycle regulations and communicate regulatory updates to faculty, management, and staff.
• Teach and train team members within designated specialty and subspecialty areas.
• Stay current with coding audits, regulations, trends, Office of Inspector General (OIG) initiatives, and payer requirements affecting assigned specialties.
• Research and review coding directives issued by OIG, CMS, intermediaries, and national and local insurance carriers.
• Analyze complex coding data, identify revenue cycle trends, and prepare reports for leadership.