Hospital Compliance Analyst II

at  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.
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?

• 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 billed.
• Perform focused documentation reviews in response to internal/external allegations as identified by Senior leadership, and Director.
• Apply knowledge of Medicare Outpatient Prospective Payment System guidelines to confirm that Penn Medicine receives appropriate reimbursement.
• Assists Senior Analyst(s) and Director in research and development of annual Compliance audit plan.
• 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 and revenue risk/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.
• Maintains 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