Compliance Analyst I

The Compliance Analyst (CA) I is responsible for audits, reviews, and education related to professional fee billing for UPHS providers. The CA I is also responsible for responding to inquiries, requests for consultation, and developing content for provider education sessions. Additionally, the CA I will prepare reports of audits and reviews within a timely fashion as well as individually conduct New Provider Education sessions complete with prepared materials. Entity & Department Entity: Corporate Services Department: Office of Billing Compliance Location: Philadelphia, PA Hours: M-F, 8 hr days, hybrid Responsibilities Performs systematic review of outpatient and inpatient records to ensure that documentation supports all billed services by UPHS providers. Performs focused medical reviews in response to internal/external allegations or as triggered by any internal/external benchmarking identified by Senior leadership and management. Prepares materials, appropriate research and audit in order to conduct a meaningful New Provider Education session. Researches topics and provides accurate guidance/response that is congruent with standards of CMS, Correct Coding guidelines as well as National Correct Coding initiative for any queries from clientele. Keeps abreast with all the changes in the CPT coding, CMS regulations, local Medicare carrier (Novitas) in order to provide the most accurate information when participating in any internal and external projects/discussions. Prepares materials necessary for the departmental quarterly finance meetings as necessary. Ensures accuracy of information while maintaining timeliness of the reports. Participates in any preparation of any reports, ensure understanding of said reports and their accuracy. i.e., executive summary reports for the senior leadership at the end of the calendar year. 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 Risk Adjustment Coder certification. (Preferred) Certified Procedural Coder (CPC) at time of hire or within 3 months of hiring. (Required) Education or Equivalent Experience H.S. Diploma/GED. (Required) 3+ years of related experience (e.g., nursing, health information management, physician assistant, fee abstraction/coding, patient accounting) or other pertinent clinical background. (Required) Bachelor's degree and 0-1 years of related experience (e.g., nursing, health information management, physician assistant, fee abstraction/coding, patient accounting) or other pertinent clinical background. (Preferred) 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. #J-18808-Ljbffr Penn Medicine