Coding and Reimbursement Analyst

13 hours ago

Philadelphia, United States Children's Hospital of Philadelphia Full time

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP's Commitment to Diversity, Equity, and Inclusion

CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.

We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview

The key responsibilities of this position involve analyzing accounts with coding denials to minimize denials, enhance collections, and assess coding and billing procedures. Furthermore, the role includes examining coding and billing issues and making necessary corrections to ensure precision and compliance with billing and coding standards. By conducting a comprehensive analysis, the role will identify patterns and collaborate closely with Revenue Integrity, Patient Financial Services, and the Coding Team to develop educational materials and workflow processes related to order and charge issues. The role will also support the manager in monitoring and identifying trends in coding denials and collection issues. This encompasses identifying opportunities for reimbursement that align with regulatory and procedural guidelines. This role will also serve as a resource and a subject matter expert for other team members.

What you will do

* Analyze claims errors/denials related to coding or charges for subsequent correction or reprocessing requests.
* Track and trend claims that are populating in the claims error work queues.
* Perform thorough reviews of accounts that still need to be billed to identify any coding-related issues. Once these issues have been identified, take necessary actions to address and resolve them effectively.
* Identify coding, clinical documentation, and billing practices that do not adhere to established guidelines.
* Research relevant third-party billing requirements and suggest solutions to prevent future denials by established regulatory and procedural guidelines.
* Develop and document a process to effectively report trends and issues to relevant stakeholders for revenue opportunities and process improvements.
* Manage HIM DNB Denials and Claims Error WQs for billing and collection accounts.
* Maintain a working knowledge of coding updates, guidelines, and regulations.
* The role is the direct contact for communication with Patient Financial Services and Revenue Integrity for coding and collection issues.
* Collaborate with Revenue Integrity, Patient Financial Services, and Coding Team for training and workflow improvement opportunities based on identified trends.
* Facilitate all coding and charge correction requests through Epic work queues. Verify documentation substantiates the request to modify claims for resubmissions to payers to expedite payment/reprocessing.
* Generate report using identified trends and data.
* Summarize report findings to present to leadership.

Education Qualifications

* High School Diploma / GED Required
* Associate's Degree Preferred

Experience Qualifications

* At least three (3) years experience in hospital inpatient and outpatient coding Required

Skills and Abilities

* EMR experience, EPIC experience (Preferred proficiency)
* 3M Encoder experience (Required proficiency)
* Demonstrated proficiency in coding regulations (Required proficiency)
* Demonstrated proficiency in hospital inpatient and outpatient coding (Required proficiency)
* Professionalism toward all staff employees, direct reports, and customers (Required proficiency)
* Knowledge of Microsoft Office Suite including PowerPoint, Excel, and Access; internet research skills (Required proficiency)
* Excellent organizational skills (Required proficiency)
* Analytical abilities (Required proficiency)
* Proficient written and verbal communication skills (Required proficiency)
* Ability to work with little supervision (Required proficiency)
* Generate report using identified trends and data (Required proficiency)
* Summarize report findings to present to leadership (Required proficiency)
* Ability to work with confidential materials and to juggle multiple tasks (Required proficiency)

Licenses and Certifications

* Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Required or
* Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire - Required or
* Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Required or
* Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association - upon hire - Required or
* Certified Professional Coder (CPC) - American Academy of Professional Coders - upon hire - Required or
* Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association - upon hire - Required

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.

Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

EEO / VEVRAA Federal Contractor | Tobacco Statement

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