Claims Edit Coder Jobs in California (NOW HIRING)

Location: Fully Remote

Employment Duration: 3 months
Patient Record 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, 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.

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:

• Work in moderate work queues daily as defined by UCSF leadership.
• Work in 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 intermediate procedures/accounts requiring advanced knowledge in charge capture, workflow, hospital operations, authorizations, and the revenue cycle.
• Resolve Claims Manager and Epic edits to ensure correct coding of services provided, including review of documentation for correct coding, evaluation and management (E/M) leveling, diagnosis coding, bundling issues, and modifier usage.
• Apply dashboards and processes for continuous analysis of moderate revenue cycle functions of diverse scope.
• Audit data input to support revenue cycle management.
• Complete coding work reports, reconcile charge lists, create charge sessions, update DEPs, follow up on credential requests, and perform related coding activities.
• Verify and correct statistical data abstracted and compiled by lower-level staff, reconcile output statistics, and perform medical coding.
• Review APeX PB Charge Edit and RFI work queues daily or as assigned, address payor inquiries requiring department review, and resolve claim edits to ensure timely billing.
• Proactively review assigned work queues and collaborate with faculty and ancillary providers regarding required documentation changes and updates.
• Run reports related to assigned charges, including missing charge reports, error reports, and other reports supporting charge capture, error resolution, and throughput.
• Under supervision, analyze charge integrity, reconciliation, and charge linkages from ancillary charging systems for the medical center/health system.

Required Qualifications

• 2-5 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 informative reports and presentations.
• Strong analytical and problem-solving skills with the ability to evaluate workflows and systems and propose 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.
• Ability to pass all classes related to UCSF Medical Center computer systems and UCSF coding and billing applications, which may include off-site billing systems from partner hospitals.
• Demonstrated intermediate 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 carrier coding and billing standards.
• One of the following certifications or an equivalent licensure as evaluated by FPRMO management:
  • 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)

Preferred Qualifications

• Secondary coding certification such as:
  • Certified Interventional Radiology Coder (CIRC)
  • Certified Emergency Department Coder (CEDC)
  • Other secondary coding certifications as applicable.

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