Hospital Compliance Analyst II DRG

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. Department: Office of Billing Compliance Philadelphia, PA (Remote) Responsible for the performance and validation of medical record documentation reviews at all hospitals owned by Penn Medicine to assure compliance with applicable federal and state coding and billing regulations.

Incumbent will also participate in performing coding research and other hospital‑based audit activity that may be necessary in support of the Department mission. Responsible for the collection, preparation, assembling and maintenance of data to perform Hospital reviews utilizing internal auditing software Direct focused Diagnosis Related Group (DRG) inpatient audits to assess the adequacy of medical record documentation, medical necessity, and compliant coding Apply knowledge of Medicare Inpatient 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 Performs second level quality assurance DRG audits of externally completed DRG audits to ensure timely and accurate reporting of final results. 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 Certified Coding Specialist (CCS), or Certified Inpatient Coder (CIC) at time of hire. (6+ years of experience in a related field, e.g.

Inpatient Hospital coding, DRG analysis, auditing, billing and statistical analysis. (CD‑10‑CM/PCS and CPT/HCPCS Levels I, II, and III coding/billing experience. (Knowledge of medical terminology. (Bachelor's degree preferred Our employee benefits programs help our employees get healthy and stay healthy. Together we will continue to make medical advances that help people live longer, healthier lives. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. #