Hospital Compliance Analyst II DRG

Responsibilities:

• 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
• Examine records to determine principal and secondary diagnoses, procedures, co-morbidities and complications, discharge disposition, present on admission indicators, and provider query process
• Perform focused documentation reviews in response to internal/external allegations as identified by Senior leadership, and Director
• 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
• Maintains certification
• 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

Credentials:

• Certified Coding Specialist (CCS), or Certified Inpatient Coder (CIC) at time of hire. (Required)

Education or Equivalent Experience:

• HS Diploma/GED. (Required)
• 6+ years of experience in a related field, e.g. Inpatient Hospital coding, DRG analysis, auditing, billing and statistical analysis. (Required)
• Course work in human anatomy and physiology. (Required)
• CD-10-CM/PCS and CPT/HCPCS Levels I, II, and III coding/billing experience. (Required)
• Knowledge of medical terminology. (Required)
• Bachelor's degree preferred