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Day (United States of America)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
The NCCI Specialist position reviews and resolves National Correct Coding Initiative (NCCI) Edits. This role involves reviewing the documentation in the medical record to ensure that CPT and HCPCS Level II codes are assigned appropriately and that modifiers are applied correctly to prevent improper payments and ensure accounts comply with CMS's National Correct Coding Initiative Policies.
What you will do
- Responsible for resolving all NCCI Edits.
- Ensures accounts are processed timely.
- Work with ancillary and other departments to ensure proper utilization of the charge master. Review charging practices to ensure appropriate charge protocols are followed and supporting documentation is acceptable and in order.
- Assign codes based on documentation in the Medical Records. Bill only accurate and appropriate documented services.
- Should be able to code outpatient surgery, outpatient registration, and emergency department records with an accuracy rate of 95% or greater.
- Assures the accuracy, integrity, and consistency of coded data.
- Utilizes and demonstrates the skill and knowledge to effectively communicate with hospital personnel, including, but not limited to, physicians, nurses, administrators, directors, and co-workers.
- Strict adherence to AHA Coding Clinic, CPT Assistant, CMS Official Guidelines for Coding and Reporting, and approved ICD-10-CM/PCS coding guidelines.
- Strict Adherence to CMS's National Correct Coding Initiative policies.
- Strict adherence to AHIMA's Standards of Ethical Coding.
- Performs other duties as assigned.
- Resolve coding and NCCI edit billing denials in coding denials work queues.
- Maintain productivity standards:
- Resolve 60 accounts daily.
- Informs supervisor of trends and opportunities for reducing NCCI edits due to incorrect CDM charging.
- Utilize the Epic EHR and HDM/3M coding system to indicate accounts pending NCCI edit resolutions.
- Critical thinking skills are a must.
- Ability to adapt to changes in workload and work functions and to effectively prioritize work assignments.
- Work collaboratively with other hospital personnel to resolve NCCI edit challenges.
Education Qualifications
- Associate's Degree Registered Health Information Administrator Preferred Required
- Bachelor's Degree Registered Health Information Administrator Preferred Preferred
Experience Qualifications
- At least four (4) years A minimum of 4 years outpatient coding experience required Required
- Outpatient and Inpatient Coding preferred
Licenses and Certifications
- Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Required or
- Registered Health Information Administrator (RHIA) - American Health Information Management Association - upon hire - Required and
- Certified Coding Specialist (CCS) - American Health Information Management Association - within 12 months - Required or
- Certified Professional Coder (CPC) - American Academy of Professional Coders - within 12 months - Required
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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