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Hospital Compliance Analyst

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Job ID: 197295
Category: Accounting/Finance
Work Type: FT
Location: Philadelphia, PA, United States
Work Schedule: Remote, Day light, FT

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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?

Hospital Compliance Analyst

Entity: Corporate Services

Department: CPUP Billing Compliance-Reimbursement

Location: 3600 Civic Center Blvd

Hours: (must live reasonable distance from location) Hours are flexible, position is remote with occasional in-office days (usually only a few times per year)


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.


  • 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 that have been submitted
  • Perform focused documentation reviews in response to internal/external allegations as identified by Senior leadership, Director and/or Associate Director
  • 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 methodology and possible revenue 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
  • Maintain 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


Minimum Requirements

Required Education and Experience

  • Bachelor's Degree is required (Preferably in nursing, health information management or a related field)
  • 1+ years experience in a related field is required (Hospital coding, billing and statistical analysis )
  • Knowledge of medical terminology is required
  • Coursework in human anatomy and physiology is required
  • ICD-10-CM/PCS and CPT/HCPCS coding/billing experience is required

Licenses, Registrations, and Certifications

  • CCA, CCS, RHIA or RHIT at hire or within 3 months of hire

Required Skills and Abilities

  • TECHNOLOGY: Ability to use Microsoft Word
  • TECHNOLOGY: Ability to use Microsoft Excel
  • TECHNOLOGY: Ability to use Microsoft Power Point
  • Hospital billing and documentation standards, particularly the Medicare OPPS/APC payment regulations
  • 3M coding and reimbursement systems and EPIC hospital billing
  • CPT Manual/CPT Assistant
  • Working knowledge of ICD-10-CM
  • Appropriate understanding and usage of the CDR (Coder's Desk Reference)
  • Familiarity with MDAudit software
  • Familiarity with PA State law website
  • Familiarity with maneuvering through the CMS website
  • Familiarity with maneuvering through the Novitas website
  • Familiarity with Penn Chart (Epic EMR)

Additional Information:

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
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