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Penn Medicine, University of Pennsylvania Health System · 1 day ago

Professional Fee Coding Quality Lead

Bala-Cynwyd, PA

Full-time

Hybrid

Senior Level

5+ years exp

Penn Medicine is dedicated to providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. The Professional Fee Coding Quality Lead is responsible for validating the accuracy of professional fees abstracted from medical records, ensuring compliance with coding guidelines, and providing leadership for coding specialists.

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Responsibilities

Validate that the appropriate ICD-10-CM diagnosis codes have been assigned in accordance with coding guidelines

Validate that appropriate CPT-4 codes for evaluation and management services and/or specified inpatient procedures have been assigned

Participate in the training process of new staff members, internal and employees of the outside contract company

Assign ICD-10-CM and CPT-4 codes to operative notes. Review the entire operative note, capture all codes, eliminate codes based on the Correct Coding Initiative (CCI) edits, attach modifier (to ensure accurate payment), and contact physician when necessary for clarification, as necessary

Assist with the coding of all clinical services, both Evaluation and Management services and operative procedures, if needed for coverage purposes

Identify coding variances when the physician codes his/her own services

Identify unbillable events by the rendering or requesting physician

Neatly and accurately complete a daily production log

Perform other duties as dictated by the Director or Manager

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

Assist with the expansion of professional fee coding to other hospitals in the Health System. Investigates physicians, billing practices, and communicates these to the outside vendor. Quality checks all work during “go live.”

Participate regularly in calls with the outside vendor to ensure proper training and quality of the professional fee coding staff

Prepare for, participate in, and follow-up afterwards in meetings with the Clinical Departments, Finance, Compliance, Physicians, etc

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

Qualification

ICD-10-CM codingCPT-4 codingCoding auditingElectronic medical recordsFederal/state documentationElectronic audit toolsInterpersonal communicationIndependent work

Required

Associate's Degree And 7+ years Experience coding and auditing inpatient and outpatient medical records

Bachelor's Degree Nursing, Health Information Management or related field And 5+ years Experience coding and auditing inpatient and outpatient medical records

Master's Degree Program track in Nursing, Health Information Management or related field And 0-1 years Experience coding and auditing inpatient and outpatient medical records. As well as 5 years extensive knowledge of complex coding in a large AMC

Certified Professional Coder - CPC (AAPC) or CCS-P (AHIMA)

Understanding of electronic medical records functionality

Demonstrated interpersonal/verbal communication skills

Extensive knowledge of ICD-10-CM and CPT-4 codes - proficiency with evaluation, management, and procedures coding experience necessary

Extensive knowledge of federal, state, and third party payer inpatient documentation requirements

Ability to perform work independently and make judgments without close oversight

Understanding of electronic audit tool use and capabilities

Benefits

Prepaid tuition assistance programs

Company

Penn Medicine, University of Pennsylvania Health System

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Penn Medicine is a world leader in academic medicine, setting the standard for cutting-edge research, compassionate patient care, and the education of future health care professionals.

Founded in 1765

Philadelphia, Pennsylvania, USA

10001+ employees