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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
Responsible for the review of coded accounts to determine the completeness and accuracy of diagnostic and procedural coding and DRG assignment for inpatient and outpatient records. Ensure that assigned codes and DRG are adequately supported by documentation and that appropriate reimbursement and severity of illness are captured. Knowledgeable in MS-DRG, APR-DRG, ICD-10 CM/PCS, CPT, and HCPCS.

What you will do

Continuous and Focused Auditing
Perform reviews of coded accounts to determine correct usage of diagnostic and procedural coding for appropriate DRG assignment.
Applies established standards benchmarks to individual and group audits.
Reviews non-CC/MCC accounts to determine coding accuracy and completeness and any need for additional documentation.
Perform focused audits as directed by management.
Perform subsequent audits resulting from corrective action.
Review accounts flagged by coding systems and outside departments.
Apply and adhere to all hospital coding guidelines as well as external regulations.
Conduct research to resolve complex coding issues.
Analytical Reporting and Communication
Identifies and communicates issues and trends from audit results to Manager.
Recommends areas of focus for education and improvement.
Maintains established rates for accuracy and productivity.
Identify anomalous coding practices that do not adhere to established guidelines.
Maintain and organize audit results in an electronically accessible and understandable structure.
Analyzes audit findings and prepares timely, meaningful statistical and suggestive reports for Manager.
Provide comparative benchmark reports of individuals and team.
Summarize audit findings for reports and presentations to leadership.
Department Support
Assists Manager in settlement of audit findings.
Assist the Manager with reviewing and responding to external and internal coding audits.
Maintain a working knowledge of new coding and DRG guidelines and regulations as well as changes to established coding and DRG guidelines and regulation. Work with the Manager to interpret and apply these changes.
Maintain a working knowledge of regulations, including billing, coding, and documentation requirements.
Maintain a strong knowledge of medical terminology and new conditions and treatments.
Maintain a proficiency in various coding structures as applicable to the hospital.
Participates in Quality Improvement initiatives and committees as needed.

Education Qualifications

Bachelor's Degree Health Information Management or related field Required

Experience Qualifications

At least three (3) years inpatient and outpatient auditing experience. Required
At least three (3) years inpatient and outpatient auditing experience. Required

Skills and Abilities

EMR experience required, EPIC experience preferred
Encoder experience required, 3M preferred
Proficient written and verbal communication skills
Professionalism toward all staff employees, direct reports, and customers
Demonstrated proficiency of coding regulations

Licenses and Certifications

Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire - Required or
Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Required
Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Preferred

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.
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