Compliance Analyst I

Entity - Corporate Services

Department - Office of Billing Compliance

Hours - Remote (NJ/DE/PA residents)

Compliance Analyst I

The Compliance Analyst (CA) I is responsible for the performance of annual reviews of the professional fee billing for the faculty members of UPHS (HUP, PMC, PAH, CCH and PMPHC) and the Clinical Care Associates (CCA). It is also responsible for focused reviews of other specialty areas within UPHS and other special projects to include, but not limited to, assisting in the creation of specialty specific departmental education sessions. Additionally, the CA I will prepare the summary report of findings within a timely fashion as well as individually conduct New Physician Education sessions complete with prepared materials. The CA I also provides guidance to the Compliance Specialist.

Accountabilities

• Performs systematic review of outpatient and inpatient records to ensure that documentation supports all billed services by the medical staff.
• Performs focused medical reviews in response to internal/external allegations or as triggered by any internal/external benchmarking identified by Senior leadership, Director and Associate Director.
• Prepares materials, appropriate research and audit in order to conduct a meaningful New Provider Education sessions.
• Researches topics and provides accurate guidance/response that is congruent with standards of CMS, Correct Coding guidelines as well as National Correct Coding initiative for any queries from clientele.
• Keeps abreast with all the changes in the CPT coding, CMS regulations, local Medicare carrier (Novitas) in order to provide the most accurate information when participating in any internal and external projects/discussions.
• Prepares materials necessary for the departmental quarterly finance meetings as necessary; ensures accuracy of information while maintaining timeliness of the reports.
• Participates in any preparation of any reports, ensure understanding of said reports and their accuracy. i.e., executive summary reports for the senior leadership at the end of the calendar year.
• 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

• Associate's Degree (Health care studies preferred) and 1+ years Related experience (nursing, health information management, physician assistant, fee Abstraction, patient billing) or other pertinent clinical background

Or

• HS Diploma and 3+ years Related experience (nursing, health information management, physician assistant, fee Abstraction, patient billing) or other pertinent clinical background

Licenses, Registrations, and Certifications

• Certified Procedural Coder (CPC) at time of hire or within 3 months of hiring

Required Skills and Abilities

• Ability to use Microsoft Outlook
• Ability to utilize computer software
• Familiarity with CPT Manual/CPT Assistant
• Familiarity with ICD-10 Manual
• 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)

Compliance Analyst II

The Compliance Analyst (CA) II is responsible for the performance of annual reviews of the professional fee billing for the faculty members of UPHS (HUP, PMC, PAH, CCH and PMPHC) and the Clinical Care Associates (CCA). It is also responsible for focused reviews of other specialty areas within UPHS and other special projects to include, but not limited to, assisting in the creation of specialty specific departmental education sessions. Additionally, the CA II will prepare the summary report of findings within a timely fashion as well as individually conduct New Physician Education sessions complete with prepared materials. CA II is responsible for providing guidance to Compliance Analyst I and Compliance Specialist.

Accountabilities

• Performs systematic review of outpatient and inpatient records to ensure that documentation supports all billed services by the medical staff with ease and confidence.
• Performs focused medical reviews in response to internal/external allegations or as triggered by any internal/external benchmarking identified by Senior leadership, Director and Associate Director with precision and accuracy.
• Prepares materials, appropriate research and audit in order to conduct a meaningful New Provider Education session.
• Researches topics and provides accurate guidance/response that is congruent with standards of CMS, Correct Coding guidelines as well as National Correct Coding initiative for any queries from clientele with proficiency.
• Keeps abreast with all the changes in the CPT coding, CMS regulations, local Medicare carrier (Novitas) in order to provide the most accurate information when participating in any internal and external projects/discussions.
• Prepares materials necessary for the departmental quarterly finance meetings as necessary; ensures accuracy of information while maintaining timeliness of the reports.
• Participates in any preparation of any reports, ensures understanding of said reports and their accuracy, i.e., executive summary reports for the senior leadership at the end of the calendar year.
• Assists and provides guidance to the Compliance Specialist and the Compliance Analyst I in any manner possible.
• 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

• Associate's Degree (Health care studies preferred) and 3+ years Related experience (nursing, health information management, physician assistant, fee Abstraction, patient billing) or other pertinent clinical background (Bachelor’s degree preferred)

Licenses, Registrations, and Certifications

• Certified Procedural Coder (CPC)

Required Skills and Abilities

• TECHNOLOGY: Ability to use Microsoft Outlook
• TECHNOLOGY: Ability to utilize computer software
• Demonstrated knowledge and use of CPT Manual/CPT Assistant
• Demonstrated knowledge and use of ICD-10 Manual
• Demonstrated knowledge and use of specific references from department library
• 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)