HIM Coding Quality Specialist

Penn Medicine, University of Pennsylvania Health System; Philadelphia (Philadelphia County); Hybrid; USD 70,000 - 110,000; Full time

Job summary

Penn Medicine seeks an experienced inpatient coder to review medical records for coding and DRG accuracy, ensuring principal and secondary diagnoses and procedures align with guidelines. You will perform audits, participate in policy development, and support enterprise coding quality initiatives.

Responsibilities include conducting second level death review for APR SOI/ROM, addressing third-party audit findings, and collaborating with clinicians and billing staff to resolve coding and

Qualifications

• Associate's degree required.
• 4+ years of inpatient coding at a tertiary care facility.
• CCS or CPC certification required; RHIA or RHIT preferred.

Responsibilities

• Review coded medical records for coding and DRG accuracy per guidelines.
• Audit for principal/secondary diagnoses and procedures; ensure correct coding.
• Develop and communicate coding policies; train staff on changes.
• Research and respond to coding inquiries from departments and providers.
• Identify and refer coding questions to management for guidance.
• Collaborate with clinicians and billing staff on documentation and reimbursement.

Skills

Auditing

Attention to detail

Communication

Training others

Education

Associate's degree in Health Information Management or related field

Tools

CPT-4 Coding

DRG assignment

HDM optimization

Job description

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.

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: Corp HIM Coding

Location: Bala Cynwyd, PA/Remote

Summary

Review coded medical records for coding and DRG and/or Evaluation and Management accuracy by verifying that the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. This shall be completed according to established coding guidelines and rules for reporting. All coding staff shall have quality audits performed on a consistent basis, the results of which are incorporated into their performance reviews.

Responsibilities

• Perform audits with 98% accuracy in the following, but not limited to, areas: subject focused, purely randomized, CPT-4 Coding, Systemic Monitoring and Review Technology (SMART) audits on 100% flagged records, discharge disposition code assignment, post discharge queries to ensure compliance with policies, Performance of these audits should adhere to coding conventions and official coding guidelines with any discrepancies being communicated to the management team.


• Audits should include a simultaneous review of all abstracted data to insure key elements are abstracted correctly.


• Participate in the development of institutional and organizational coding policies. Provide training to new and existing coding staff to ensure understanding of these policies and to communicate any changes to the policies, procedures, and workflows of the department.


• Research, review and respond to the following, but not limited to, inquiries for coding information: general coding and coding quality questions or issues from various internal and external departments, the coding staff, the coding quality review staff, Office of Billing Compliance, providers, etc.


• Identify, communicate, and refer coding classification, HDM, DRG assignment, E&M/CPT assignment and severity of illness assessment questions to management in a timely manner for determination and guideline development.


• Communicate with co-workers, management, physicians, and other hospital staff regarding clinical documentation and reimbursement issues. This includes communicating with departments on rebilling of accounts that need correction (i.e. coding, bill area, clinician).


• Perform second level death review for all APR SOI and ROM Scores below 4 and communicate summary of findings to the appropriate Physician Service.


• Respond to all third party audit findings (i.e., Viziant, Quality Insights, Americhoice, IBC), as needed, for RAC activity, interdepartmental audits, etc.


• Assist with the month end close out process and maintenance of the IP by any, but not limited to the following activities: contacting CRM for disposition, contacting Surgeons for OP notes, answering coder questions, query completion, missing documentation, as needed.


• 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

Credentials

• CCS or CPC is required.


• RHIA or RHIT is preferred.

Education or Equivalent Experience

• Associate's degree is required.


• 4+ years of inpatient coding at a tertiary care facility, preferably in an academic medical center or in the case of CFA experience coding procedures and professional coding of medical records is required.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. 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.