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Professional Fee Coding Quality Lead

Penn Medicine, University of Pennsylvania Health System • Bala-Cynwyd, PA

Entry level Posted March 4, 2026 Job link

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Responsibilities

Commitments

Responsibilities

Validate the accuracy of the professional fees abstracted from the medical record.
Ensure that the clinical documentation substantiates the evaluation, management, procedure, and modifiers selected in accordance with federal, state and hospital documentation and coding requirements.
Ensure documentation in the medical record supports the changes abstracted and are in compliance with organization and Medicare guidelines and regulations.
Provide support and leadership for Professional Fee Coding Quality Specialists.
Validate that the appropriate ICD-10-CM diagnosis codes have been assigned in accordance with coding guidelines.
Validate that appropriate CPT-4 codes for evaluation and management services and/or specified inpatient procedures have been assigned.
Participate in the training process of new staff members, internal and employees of the outside contract company.
Assign ICD-10-CM and CPT-4 codes to operative notes.
Review the entire operative note, capture all codes, eliminate codes based on the Correct Coding Initiative (CCI) edits, attach modifier (to ensure accurate payment), and contact physician when necessary for clarification, as necessary.
Assist with the coding of all clinical services, both Evaluation and Management services and operative procedures, if needed for coverage purposes.
Identify coding variances when the physician codes his/her own services.
Identify unbillable events by the rendering or requesting physician.
Neatly and accurately complete a daily production log.
Perform other duties as dictated by the Director or Manager.
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
Assist with the expansion of professional fee coding to other hospitals in the Health System.
Investigates physicians, billing practices, and communicates these to the outside vendor.
Quality checks all work during “go live.”
Participate regularly in calls with the outside vendor to ensure proper training and quality of the professional fee coding staff.
Prepare for, participate in, and follow-up afterwards in meetings with the Clinical Departments, Finance, Compliance, Physicians, etc.
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

Not Met Priorities

What still needs stronger evidence

Requirements

Associate's Degree And 7+ years Experience coding and auditing inpatient and outpatient medical records
Bachelor's Degree Nursing, Health Information Management or related field And 5+ years Experience coding and auditing inpatient and outpatient medical records
Master's Degree Program track in Nursing, Health Information Management or related field And 0-1 years Experience coding and auditing inpatient and outpatient medical records.
As well as 5 years extensive knowledge of complex coding in a large AMC
Licenses, Registrations, and Certifications
Certified Professional Coder - CPC (AAPC) or CCS-P (AHIMA)
EMR: Understanding of electronic medical records functionality
COMMUNICATION: Demonstrated interpersonal/verbal communication skills
Extensive knowledge of ICD-10-CM and CPT-4 codes - proficiency with evaluation, management, and procedures coding experience necessary
Extensive knowledge of federal, state, and third party payer inpatient documentation requirements.
Ability to perform work independently and make judgments without close oversight.
Understanding of electronic audit tool use and capabilities

Education

(Not required) – Associate's Degree And 7+ years Experience coding and auditing inpatient and outpatient medical records
(Not required) – Or
(Not required) – Bachelor's Degree Nursing, Health Information Management or related field And 5+ years Experience coding and auditing inpatient and outpatient medical records
(Not required) – Or
(Not required) – Master's Degree Program track in Nursing, Health Information Management or related field And 0-1 years Experience coding and auditing inpatient and outpatient medical records.
(Not required) – As well as 5 years extensive knowledge of complex coding in a large AMC
(Not required) – Licenses, Registrations, and Certifications
(Not required) – Certified Professional Coder - CPC (AAPC) or CCS-P (AHIMA)

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: Corporate Services
Department: Central Fee Abstract Corp
Location: 150 Monument Blvd
Hours: Hybrid, M-F, daylight (team usually starts between 5am and 6:30am but has some flexibility with manager approval)
Validate the accuracy of the professional fees abstracted from the medical record. Ensure that the clinical documentation substantiates the evaluation, management, procedure, and modifiers selected in accordance with federal, state and hospital documentation and coding requirements. Ensure documentation in the medical record supports the changes abstracted and are in compliance with organization and Medicare guidelines and regulations. Provide support and leadership for Professional Fee Coding Quality Specialists.
Accountabilities

Validate that the appropriate ICD-10-CM diagnosis codes have been assigned in accordance with coding guidelines.
Validate that appropriate CPT-4 codes for evaluation and management services and/or specified inpatient procedures have been assigned.
Participate in the training process of new staff members, internal and employees of the outside contract company.
Assign ICD-10-CM and CPT-4 codes to operative notes. Review the entire operative note, capture all codes, eliminate codes based on the Correct Coding Initiative (CCI) edits, attach modifier (to ensure accurate payment), and contact physician when necessary for clarification, as necessary.
Assist with the coding of all clinical services, both Evaluation and Management services and operative procedures, if needed for coverage purposes.
Identify coding variances when the physician codes his/her own services.
Identify unbillable events by the rendering or requesting physician.
Neatly and accurately complete a daily production log.
Perform other duties as dictated by the Director or Manager.
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
Assist with the expansion of professional fee coding to other hospitals in the Health System. Investigates physicians, billing practices, and communicates these to the outside vendor. Quality checks all work during “go live.”
Participate regularly in calls with the outside vendor to ensure proper training and quality of the professional fee coding staff.
Prepare for, participate in, and follow-up afterwards in meetings with the Clinical Departments, Finance, Compliance, Physicians, etc.
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
Minimum Requirements
Required Education and Experience

Associate's Degree And 7+ years Experience coding and auditing inpatient and outpatient medical records
Or

Bachelor's Degree Nursing, Health Information Management or related field And 5+ years Experience coding and auditing inpatient and outpatient medical records
Or

Master's Degree Program track in Nursing, Health Information Management or related field And 0-1 years Experience coding and auditing inpatient and outpatient medical records. As well as 5 years extensive knowledge of complex coding in a large AMC
Licenses, Registrations, and Certifications

Certified Professional Coder - CPC (AAPC) or CCS-P (AHIMA)
Required Skills And Abilities

EMR: Understanding of electronic medical records functionality
COMMUNICATION: Demonstrated interpersonal/verbal communication skills
Extensive knowledge of ICD-10-CM and CPT-4 codes - proficiency with evaluation, management, and procedures coding experience necessary
Extensive knowledge of federal, state, and third party payer inpatient documentation requirements.
Ability to perform work independently and make judgments without close oversight.
Understanding of electronic audit tool use and capabilities
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.