Penn Medicine
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.
Job Summary
- 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.
Responsibilities
- 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).
Credentials
- Certified Professional Coder - CPC (AAPC) (Required).
- Driver's License (Required).
Education or Equivalent Experience
- Bachelor's Degree in HIM, Healthcare or Other related field (Required).
- 2+ years coding medical professional services experience (Required).
- 1+ years experience interacting directly with physicians and other allied health professionals (Required).
