Current UPHS employees must apply HERE
Coding Quality Specialist
Job ID: 153412
Work Type: FT
Location: Radnor, PA, United States
Date Posted: Mar 7, 2023
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?
The Coding Quality Specialist will review coded medical records for coding and DRG accuracy by verifying that the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures have been documented, assigned, and billed at the appropriate level for reimbursement to which the facility is legally entitled. This shall be completed according to established coding guidelines and rules for reporting. The incumbent will ensure documentation in the medical record supports the charges and are in compliance with Penn Medicine and Medicare guidelines and regulations. Travel to various practice locations (10-20%) is expected to provide physician education as determined from the review.
- Audit appropriate ICD-9-CM/ICD-10-CM diagnosis codes in accordance with coding guidelines.
- Audit appropriate CPT-4 codes for evaluation and management services and specified procedures.
- Identify unbillable events due to insufficient documentation by the rendering or requesting physician.
- Identify coding or documentation variances.
- Research, review and respond to coding and coding quality issues and questions from various internal and external departments.
- Neatly and accurately complete the appropriate memorandum and attach the supporting documentation when communicating to providers and other parties about code variances and unbillable events.
- Meet production goals set by the Director of Revenue Process and Finance Team.
- Summarize and report quality results and coder productivity on a weekly basis and submit to management monthly.
- Identify and communicate documentation issues and concerns that influence coding to management as identified.
- Respond to all third party audit findings (i.e., Viant, Quality Insights, Americhoice, IBC), as needed, for RAC activity
- Participate in the development of institutional and organizational coding policies.
- Follow all department policies for the correct completion and processing of coded encounters.
- Schedule education sessions with providers (at their practice/location) to review coding guidelines and EMR documentation.
- Conduct provider education on a quarterly basis (PennChart Academy).
- 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
Required Education and Experience
- Bachelor's Degree (in HIM, healthcare, or related field) is required.
- 2+ years of relevant coding medical professional services experience is required (Additional experience may be considered in lieu of degree.)
- 1+ years of experience interacting directly with physicians and other allied health professionals is required.
Licenses, Registrations, and Certifications
- Certified Procedural Coder – CPC (AAPC)
- Active driver’s license for state of residence
Required Skills and Abilities
- Knowledge of medical terminology, human anatomy and physiology, and clinical disease processes
- Ability to effectively present information and respond to questions from others
- Ability to communicate effectively with all levels of staff
- Extensive knowledge of Epic, ICD-9-CM, ICD-10-CDM and CPT-4 codes - proficiency with evaluation and management codes, procedural and surgical operative notes.
- Must have knowledge of federal, state, and third party payer inpatient documentation requirements.
- Must have knowledge of HIPAA Regulations.
Department: AR Project-Management
Position Address: Penn Medicine Radnor- 145 King of Prussia Rd
As part of our COVID-19 response, this position may currently be offering partial or full remote work. However, in the near future this position will require full or partial on-site work.
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.
Current UPHS employees must apply HERE