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Professional Fee Compliance Analyst


At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.

We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained four-year Magnet ® recognition status for the fourth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.

PENN MEDICINE LANCASTER GENERAL HEALTH offers a comprehensive benefits package:

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 so that our employees can stay actively engaged and committed to living their legacy every day. Together, we will continue to make medical advances that help people live longer, healthier lives.

Join us and be part of a team that empowers you to do more than your job and encourages you to:

Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.

Company

Lancaster General Hospital

Cost Center

2081 Compliance

Supervisory Organization

Compliance

Grade

G14

Benefits of Joining Penn Medicine Lancaster General Health:

PENN MEDICINE LANCASTER GENERAL HEALTH combines a Nationally Ranked Hospital with great schools, safe neighborhoods, affordable housing, local community events and festivals as well as a wealth of cultural and recreational activities. The scenic Susquehanna River Valley provides opportunities for fishing, skiing, kayaking, hiking and mountain biking in addition to easy access to NJ shoreline or Delaware beaches. Urban life is easily accessible, with New York, Baltimore, Philadelphia and Washington D.C. a train ride away. Local universities, Fulton Theatre, the downtown shopping and dining district and local sports teams make Lancaster a great place to Live, Work and Play.

Summary

This position is located in Lancaster, Pa

HOURS: Full Time- Day Shift- No weekends/holidays

At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.

PENN MEDICINE LANCASTER GENERAL HEALTH, a member of the University of Pennsylvania Health System (Penn Medicine), is a not-for-profit health system with a comprehensive network of care encompassing Lancaster General Hospital (LGH), Women & Babies Hospital and the Lancaster Rehabilitation Hospital (a partnership with Kindred Healthcare). We are an Accredited Trauma Center-Level II through the Pennsylvania Trauma Systems Foundation with 786 Licensed beds.  Our membership in Penn Medicine brings together the strengths of a world-renowned, not-for-profit academic medical center and a nationally recognized, not-for-profit community healthcare system.
 

We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained four year Magnet ® recognition status for the fourth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.

Join us and be part of a team that empowers you to do more than your job and encourages you to:

Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.

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.

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.
  • 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

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.

BURLE Full Time Posted on 11/04/2020