Professional Fee Coding Quality Lead

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?

Entity:
Corporate Services

Department:
Central Fee Abstract Corp

Location:

150 Monument Blvd

Hours:

Hybrid, M-F, daylight (team usually starts between 5am and 6:30am but has some flexibility with manager approval)

Validate the accuracy of the professional fees abstracted from the medical record. Ensure that the clinical documentation substantiates the evaluation, management, procedure, and modifiers selected in accordance with federal, state and hospital documentation and coding requirements. Ensure documentation in the medical record supports the changes abstracted and are in compliance with organization and Medicare guidelines and regulations. Provide support and leadership for Professional Fee Coding Quality Specialists.

• 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.

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

Or

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

Or

• 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)

• EMR:
  Understanding of electronic medical records functionality
• COMMUNICATION:
  Demonstrated interpersonal/verbal communication skills
• Extensive knowledge of ICD‑10‑CM and CPT‑4 codes – proficiency with evaluation, management, and procedures…