003306

PRIMARY FUNCTION :

Coding Audit and Compliance Administrator has the responsibility for developing, implementing and maintaining a data quality compliance plan for inpatient and outpatient coding and reimbursement. The Coding Audit and Compliance Administrator will assist the Senior Director of Health Information Management and Director of Coding and Data Operations with the development of coding policies and procedures. Coordinates and conducts reviews of targeted cases to assure timely billing process and correct hospital reimbursement. Performs daily and random audits to validate accuracy of MS-DRG, APC and coding assignments to ensure compliance with coding and billing requirements.

The position includes, but is not limited to the following essential functions.

ESSENTIAL FUNCTIONS :

• Responsible for developing, implementing and maintaining a coding quality compliance plan for outpatient coding and reimbursement
• Coordinates and conducts daily reviews of targeted cases to assure timely billing process and correct hospital reimbursement
• Perform random audits and reviews on denied cases to validate accuracy of MS-DRG and APC coding assignments to ensure compliance with coding and billing requirements
• Perform follow-up and focused audits as directed and as necessary
• Serve as a resource for coding, charging, and billing staff from TJUH facilities who have questions and seek clarification
• Interacts with co-workers, visitors, and other staff consistent with the core values of the Hospital.

Qualifications

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma or GED. Bachelor's degree preferred.

CERTIFICATES, LICENSES, AND REGISTRATION:

Certified Coding Specialist (CCS) required.

Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT) preferred.

EXPERIENCE REQUIREMENTS:

Minimum of five years previous coding and coding auditing experience required

Closing Statement

Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds.

Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science.

Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnet®-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership.

Jefferson's mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results.

• OUR MISSION: We improve lives.
• OUR VISION: Reimagining health, education and discovery to create unparalleled value
• OUR VALUES: Put People First, Be Bold & Think Differently and Do the Right Thing

As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.

Par Reference Code

101056