Hospital Compliance Analyst II

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Hospital Compliance Analyst II
Job Summary:

• Responsible for the performance and validation of medical record documentation reviews at all hospitals owned by Penn Medicine to assure compliance with applicable federal and state coding and billing regulations. Incumbent will also participate in performing coding research and other hospital-based audit activity that may be necessary in support of the Department mission.

Responsibilities:

• Perform focused APC audits to assess the adequacy of medical record documentation to ensure that it supports the ICD-10-CM diagnosis and CPT/HCPCS procedure codes billed.
• Perform focused documentation reviews in response to internal/external allegations as identified by Senior leadership, and Director.
• Apply knowledge of Medicare Outpatient Prospective Payment System guidelines to confirm that Penn Medicine receives appropriate reimbursement.
• Assists Senior Analyst(s) and Director in research and development of annual Compliance audit plan.
• Participate in special reviews, investigations of allegations, focused medical reviews and external audits of all Penn Medicine areas.
• Prepare analysis of audit results to include formal report of findings with recommendations and corrective action.
• Prepare and perform billing compliance education sessions for appropriate staff to include development of case studies based upon medical chart examples that emphasize correct coding and revenue risk/opportunities.
• Assure government compliance by advising faculty, providers, inpatient coders and other appropriate staff of major regulatory changes and coding updates and facilitate risk reduction attributable to chart documentation.
• Research and develop materials for the UPHS Billing Compliance website.
• Maintains certification.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials:

• Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Certified Outpatient Coder (COC) or Certified Inpatient Coder (CIC) at time of hire (Required).

Education or Equivalent Experience:

• H.S. Diploma/GED (Required).
• 6+ years of experience in a related field, e.g. Outpatient Hospital coding, APC analysis, auditing, billing and statistical analysis (Required).
• Knowledge of medical terminology (Required).
• Coursework in human anatomy and physiology (Required).
• ICD-10-CM/PCS and CPT/HCPCS coding/billing experience (Required).
• Bachelor's degree, preferably in nursing, health information management or a related field (Preferred).

Skills & Abilities:

• Hospital billing and documentation standards, particularly the Medicare OPPS/APC payment regulations.
• CPT Manual/CPT Assistant.
• Working knowledge of ICD-10-CM.
• Appropriate understanding and usage of the CDR (Coder's Desk Reference).
• Familiarity with audit software.
• Familiarity with maneuvering through the CMS website.
• Familiarity with maneuvering through the Novitas website.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.