Penn Medicine (University of Pennsylvania Health System)
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life’s work?
Take your coding experience to a new level, and join the Penn Medicine team as a Senior Hospital Compliance Analyst!
This role is 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 regulations. Also participates in performing coding research and other hospital based audit activity that may be necessary in support of the department mission.
- Responsible for the collection, preparation, assembling and maintenance of data to perform Hospital reviews utilizing Horizon Performance Manager (HPM) software.
- Directs focused Ambulatory Payment Classification (APC) audits to assess the adequacy of medical record documentation to ensure that it supports the ICD-10-CM diagnosis and CPT/HPCS procedure codes that have been submitted.
- Performs second level quality assurance DRG audits of externally completed DRG audits to ensure timely and accurate reporting of final results.
- Performs focused documentation reviews in response to internal/external allegations as identified by senior leadership, Director and/or Associate Director of the department.
- Manages and expedites special reviews, investigations of allegations, focused medical reviews and external audits of all Penn Medicine areas.
- Prepares analysis of audit results and generates formal report of findings with recommendations to include complete and corrective action.
- Prepares and performs billing compliance education sessions for appropriate staff to include development of case studies based upon medical chart examples that emphasize correct coding methodology and possible revenue opportunities.
- Assures 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.
- Researches and develops 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
- 2+ years of experience in a related field, e.g. hospital coding, billing and statistical analysis, required
- ICD-10-CM/PCS and CPT/HCPCS levels I, II, and III coding and billing experience required
- Ability to use MS Office suite (Excel, PowerPoint, Word) required
- Must have experience with hospital billing and documentation standards, particularly the Medicare DRG and OPPS/APC payment regulations
- 3M coding and reimbursement systems and EPIC hospital coding experience preferred
- Bachelor’s degree required, preferably in Nursing, HIM, or a related field
- Must have knowledge of medical terminology
- Must have had course work in human anatomy and physiology
- Must be a Certified Coding Specialist (CCS) or Certified Procedural Coder (CPC) at time of hire or within 6 months of employment
Below is a link to the most up to date and complete benefits package. Using this link you will be able to find our medical plan comparison charts, cost guides, and specific information about the 403(B) plan.
Instructions for Resume Submission:
Interested candidates should apply online using the link below or search for Job ID 74227 on our career’s site.