Lead Profee Auditor
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Job ID: 160145
Category: Health Information Management/Coding
Work Type: FT
Location: Philadelphia, PA, United States
Work Schedule: Full Time
Description
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?
Lead Fee Abstractor
Corporate Services
1500 Market Street, Philadelphia, PA
*Primarily remote but may occasionally require on site presence*
Summary:
Validate the accuracy of the professional fees abstracted from the record. Ensure that the clinical documentation substantiates the evaluation, management, procedure, and modifiers selected in accordance with federal, state and hospital documentation and coding requirements.
Ensure documentation in the medical record supports the charges abstracted and are in compliance with organization and Medicare guidelines and regulations. Abstract professional fees from the discharged inpatient medical records for all services.
Responsibilities:
- Validate that the appropriate ICD-10-CM diagnosis codes have been assigned in accordance with coding guidelines.
- Validate that appropriate CPT-4 codes for evaluation and management services and specified inpatient procedures have been assigned.
- Assist with the expansion of Fee Abstraction to other hospitals in the Health System. Investigates physicians, billing practices, and communicates these to the outside vendor. Quality checks all work during “go live”.
- Participate regularly in calls with the outside vendor to ensure proper training and quality of the abstraction staff.
- Prepare for, participate in, and follow-up afterwards in meetings with the Clinical Departments, Finance, Compliance, Physicians, etc.
- Participate in the training process of new staff members, internal and employees of the outside contract company.
- Audit encounter forms for each physician's services being abstracted. Follow all department policies for the correct completion and processing of these forms.
- Assign ICD-10-CM and CPT-4 codes to operative notes. Review the entire operative note, capture all codes, eliminate codes based on the Correct Coding Initiative (CCI) edits, attach modifier (to ensure accurate payment), and contact physician when necessary for clarification.
- Assist with the coding of all clinical services, both Evaluation and Management services and operative procedures, if needed for coverage purposes.
- Identify coding variances when the physician precodes his/her services.
- Identify unbillable events due to insufficient documentation by the rendering or requesting physician.
- Perform other duties as dictated by the Director and Associate Director.
Credentials:
- Certified Professional Coder - CPC (AAPC) OR Certified Coding Specialist-Physician Based - CCS-P (AHIMA) required.
Education or Equivalent Experience:
- Associate's Degree required.
- 5+ years work experience in professional coding, preferably in an academic medical center required.
- Extensive knowledge of medical terminology, human anatomy and physiology required.
- Bachelor's Degree preferred, in Health Information Management, Nursing, or related field.
Skills and Abilities:
- EMR: Understanding of electronic medical records functionality required.
- COMMUNICATION: Demonstrated interpersonal/verbal communication skills required.
- Extensive knowledge of ICD-10-CM and CPT-4 codes - proficiency with evaluation, management, and procedures coding experience necessary required.
- Extensive knowledge of federal, state, and third party payer inpatient documentation requirements required.
- Ability to perform work independently and make judgments without close oversight required.
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.
