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ProFee Compliance Analyst


Summary

Job Description

POSITION SUMMARY: The Pro Fee Compliance Analyst is responsible for supporting the Penn Medicine Office of Billing Compliance and Review Services (OBC) by reviewing, promoting and evaluating professional coding and professional fee billing.  This position is responsible for the performance of annual reviews of professional fee billing specifically for Penn Medicine Lancaster General Health Physicians (LGHP) and certain LGH Practices. The Pro Fee Compliance Analyst is responsible for risk-based reviews of professional billing and coding practices as it relates to government payors. Pro-Fee Compliance Department Analyst works in accordance with the Penn Medicine Lancaster General Health Compliance Program and the OBC  Billing Compliance Manual, the OBC New Prover Manaul and the OBC Annual Audit Process. The Pro-Fee Compliance Department Analyst serves as a role model for compliant and ethical behavior consist with the mission, vision and values of Penn Medicine and Penn Medicine LG Health.

LOCATION: Lancaster, PA

HOURS: Full time (40 Hours per Week), Hybrid Remote - business hours

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

  • Perform systematic reviews of professional fee billing and coding ensuring that documentation supports billed services.
  • Performs focused medical reviews in response to internal/external allegations or as triggered by internal/external benchmarking, and audit findings.
  • Identify patterns in denials working with appropriate parties to correct errors and mitigate future errors.
  • Monitors CMS federal regulations, local Medicare Administrative Contractor guidance, state rules, regulations, and trade publications.
  • Analyzes potential risk to the enterprise related to CMS rules, Medicare Administrative Contractor guidance, and industry news.
  • Researches topics with the capability to interpret complex rules and regulations.
  • Keeps abreast of CPT coding changes.
  • Demonstrates technical/professional expertise and understanding related to elements of the compliance role.
  • Evaluates adherence to policies and procedures with respect to coding and billing.
  • Provides accurate guidance/response congruent with standards of CMS, correct coding guidelines, National Correct Coding Initiatives from client inquiries.
  • Compiles and presents summary reports on findings from audits for Executive Management according to Office of Billing Compliance and Penn Medicine LG Health  protocols that highlight deficiencies and recommend corrective actions.
  • Compiles and prepares materials for meetings as necessary; ensures accuracy of information provided.
  • Ability to educate providers as required from research and audit findings as needed.
  • Raise issues and concerns to the Penn Medicine LG Health Compliance Manager, designee or other appropriate resource to validate and re mediate problems.
  • Participate in external audits from the Center of Medicare and Medicaid Services (CMS), Recovery Audit Contractors (RAC) and Medicare Administrative Contractor (MAC), Office of Inspector General (OIG) and Department of Justice (DOJ), as necessary.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

  • Coordinates interdepartmental and intradepartmental team approaches to review findings.
  • Performs other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

  • Bachelor’s degree, preferably in healthcare related field such as Health Information Management, Health Administration, Nursing, OR proof of equivalent work related experience.
  • Must hold current coding certificate such as: CPC, Registered Health Information Administrator (RHIA), Hospital Coding Certificate (CCS), other coding certificates (e.g. RHIT, CCS-P, CPC-H COC, CCS, CPMA),
  • Three (3) or more years of practical experience in health care regulation.
  • Extensive knowledge of various coding and reimbursement systems and coding experience.
  • Knowledge of rules and regulations pertaining to federally funded programs (e.g. Medicare and Medicaid) along with knowledge of documentation requirements for coding and billing.
  • Highly developed analytical and organizational skills; excellent written and verbal communication skills and the ability to articulate difficult concepts in an understandable manner.
  • Knowledge of Microsoft Word, Excel, Power Point and Outlook

PREFERRED QUALIFICATIONS:

  • Experience with electronic health records, preferably EPIC.
  • Extensive experience with coding software products.
  • Experience with technical writing/report writing.

    

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely. #LI-MD1

                      

Benefits At A Glance:

PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:

  • 100% Tuition Assistance at The Pennsylvania College of Health Sciences
  • Paid Time Off and Paid Holidays
  • Shift, Weekend and On-Call Differentials
  • Health, Dental and Vision Coverage
  • Short-Term and Long-Term Disability
  • Retirement Savings Account with Company Matching
  • Child Care Subsidies
  • Onsite Gym and Fitness Classes

Disclaimer

PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

 

Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.

MILL Full Time Posted on 04/25/2022