Coding Quality Specialist

Entity: Penn Primary Care and Specialty Practices

Department: Revenue Cycle

Location:Work from home with expectation to travel to practices for education as needed (10%)- PA & NJ

Hours: Full-time, M-F

The Coding Quality Specialistwill 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.

Accountabilities

• 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).
• 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

• Bachelor's Degree (in HIM, healthcare, or related field) is required.
• 2+ years of relevant coding medical professional services experience is required (Additional experience may be considered in lieu of degree.)
• 1+ years of experience interacting directly with physicians and other allied health professionals is required.

Licenses, Registrations, and Certifications

• Certified Professional Coding- CPC (AAPC)- Required
  
• Active driver’s license for state of residence

Required Skills and Abilities

• Knowledge of medical terminology, human anatomy and physiology, and clinical disease processes
• Ability to effectively present information and respond to questions from others
• Ability to communicate effectively with all levels of staff
• Extensive knowledge of Epic, ICD-9-CM, ICD-10-CDM and CPT-4 codes - proficiency with evaluation and management codes, procedural and surgical operative notes.
• Must have knowledge of federal, state, and third party payer inpatient documentation requirements.
• Must have knowledge of HIPAA Regulations.