Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Entity: CCA-Penn Primary Care and Penn Specialty Practices
Department: Population Health
Location: Penn Medicine Hospice- 150 Monument Road
Hours: FT
Job Summary:
The Ambulatory Coding and Documentation Specialist reports to the Manager of Value Based Incentive Programs with an affiliation with the ambulatory billing & compliance team. The primary objective of this position is to improve the accuracy of coding, compliance and clinical documentation. The Certified coder (CPC and CRC) is responsible for detailed analysis of outpatient medical record documentation to ensure appropriate and correct coding.
Accountabilities:
• Review and analyze medical records to accurately assign ICD-10-CM, CPT®, and risk adjustment codes in accordance with coding guidelines, CMS, HHS, and payer-specific requirements.
• Perform prospective and retrospective chart reviews to identify, validate, and capture diagnoses affecting CMS-HCC, HHSHCC, and other risk adjustment models while ensuring diagnosis accuracy, completeness, and specificity.
• Conduct clinical documentation reviews to identify documentation gaps, ensure coding compliance, and collaborate with
providers to improve diagnosis capture, coding accuracy, and quality outcomes.
• Review authorizations, claims, and coding-related billing issues to ensure services are accurately documented, coded, and
reimbursed
• Partner with clinical, population health, compliance, and billing teams to support strategic initiatives, process
improvements, and special projects.
• Educate providers and staff on coding, documentation, compliance, and risk adjustment requirements using audit findings
and best practices.
• Conduct coding audits and documentation reviews to ensure compliance with CMS regulations, payer requirements, and
organizational policies.
• Analyze coding trends, audit results, and performance data to identify improvement opportunities and support operational
goals.
• 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
Qualifications:
H.S Diploma/GED and 2+ years of ICD-10-CM coding experience, preferably in risk adjustment, population health, managed care, or value-based care.
Associates Degree preferred
Licenses/Registrations/Certs:
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 that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
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.