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?
Data Coordinator, Government Audits and Appeals
Job Summary:
- The Data Coordinator, Government Audits & Appeals is responsible for the daily management and tracking of Government audit activity received by Penn hospitals, provider groups and alternative care settings. Under the direction of the Director of Hospital Compliance, Government Audit and Appeals, receives, reviews, and enters data into the audit tracking database according to established procedures. Ensures accuracy of all data recorded and performs database maintenance functions. Responsible for the data entry and organization of documents related to government audits, to include coding and medical necessity reviews. Logs medical record requests and audit results, pulls required information together in a timely manner, submits information to audit firms, coordinates appeals documentation, and tracks appeal status. Performs initial analysis of audit issues to identify patterns and areas of improvement throughout the health system. Balances competing priorities and multiple deadlines for audits and projects. Performs additional department duties, as needed.
Responsibilities:
- Responsible for the data entry and organization of documents related, but not limited to, Office of the Inspector General (OIG), Recovery Audit Contractors (RAC), Medicaid Integrity Contractors (MIC), Zone Program Integrity Contractors (ZPIC), Comprehensive Error Rate Testing (CERT), Payment Error Rate Measurement (PERM), Medicaid Integrity Program (MIP) and/or Medicare Administrative Contractor (MAC) audits. Including receiving, compiling, and forwarding demand letters related to physician RAC audits to responsible hospital and practice personnel. Appropriately files audit documents for all entities.
- Coordinates with Analyst, Government Audit and Appeals to ensure appropriate communication of audit requests and findings to Health Information Management, Patient Accounting, Billing Office personnel, Case Management, and other clinical/operational departments. Completes and processes various general forms including RAC Discussion request form, Reconsideration and Redetermination appeal forms, and third-party vendor appeal referral forms. Organizes appeal documentation sent by third party appeal vendor for internal records and tracking purposes.
- Supports efforts with Patient Accounting and Compliance related to receipt and reconciliation of denial notices from the contractor and N432 RAC remarks. Reviews 835/837 data for payments or denials, interprets data and processes accordingly; confirms payments with Patient Accounting.
- Maintains accurate tracking of requests for records, correspondence, actions, and outcomes. Monitors and ensures deadlines are met. Escalates issues to management accordingly.
- Conducts initial analysis of audit reasons and patterns. Researches and provides applicable National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).
- Tests audit system enhancements and reports defects and system issues to management. Acts as a resource for troubleshooting with audit tracking software.
- Demonstrate judgment and discretion when handling correspondence and documentation.
- Provides up-to-date and accurate data for compliance reporting purposes.
- Maintains confidentiality with respect to medical records and corporate documents (HIPAA, JCAHO, etc.)
- Performs other general clerical and administrative duties for external audits, as needed.
- 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
Education or Equivalent Experience:
- H.S. Diploma/GED (Required)
- 1+ year of experience with healthcare field (Required)
- Knowledge of medical billing and medical terminology (Preferred)
Skills & Abilities:
- Ability to use Microsoft Outlook
- Ability to use Microsoft Excel
- Ability to use Microsoft Word
- Ability to adapt to change and handle multiple tasks in a complex environment.
- Ability to work independently, take initiative, and demonstrate critical thinking skills.
- Ability to maintain confidential information.
- Ability to pay close attention to detail and follow through with action plans.
- Ability to sit and view computer terminal for long periods of time.
- High performance Quality Control at a minimum of 96% accuracy.
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.
