Hospital Compliance Analyst

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.

Accountabilities

• 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.