Physician Billing Compliance Specialist

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A Brief Overview

Job Summary

This role is responsible for reviewing and analyzing billing processes, conducting documentation, coding, and billing audits, and ensuring compliance with applicable healthcare regulations for the Children’s Hospital of Philadelphia Practice Association (CHOPPA).

The position serves as a core compliance and coding support resource across both inpatient and outpatient settings.

The role works closely with other compliance team members, physician leadership, and operational partners, including professional billing (PB) coders, physicians, Advanced Practice Providers, residents, and fellows. Responsibilities include auditing both professional coding and provider documentation to ensure accuracy, regulatory compliance, and alignment with organizational standards.

In addition to audit functions, this role provides education and guidance to providers and coders, meeting regularly with multidisciplinary groups to support compliant documentation and coding practices. The position supports all provider types and specialties, including surgery, anesthesia, critical care, and other clinical areas, with exposure across every physical area of the organization.

Strong communication and presentation skills are essential, as the role requires frequent interaction with diverse clinical and coding audiences.

Experience or strong interest in anesthesia and radiology coding is highly desirable!

Most Relevant Required Certifications (upon hire):

• Certified Coding Specialist (CCS) – AHIMA or NHA, or

• Certified Coding Specialist–Physician-Based (CCS-P) – AHIMA, or

• Certified Professional Coder (CPC) – AAPC

Schedule:

• Standard schedule, with some team members working 7:30 a.m.–4:00 p.m.

• Flexibility available after the first 90 days.

What you will do

1. Systematically monitor, review and analyze patient medical records to determine all appropriate diagnosis and procedures performed. Provide feedback and education to providers.

2. Conduct chart audits to ensure providers are in compliance with coding and regulatory guidelines.

3. Provide feedback to director regarding audit results.

4. Maintaining thorough knowledge of coding and documentation requirements outlined by CPT, ICD-9-CM and CHOP Compliance for all physician services performed.

5. Develop and provide coding and documentation seminars for the providers.

6. Inform providers/directors each year of coding changes for the following year.

7. Work with Epic support to ensure that new codes are entered into the system in a timely manner.

8. Meet with members of CHOP’s Coding and Compliance Department to ensure department policies are line with the hospital.

9. Provide coding training to new physicians hired, annually, and as requested by the division. This includes training for new regulations and any trends or issues that identified.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least three (3) years experience in related field Required
• Physician billing Preferred
• teaching physician guidelines Preferred

Required Skills and Abilities

• Knowledge of Microsoft Office Suite including PowerPoint, Excel and Access; internet research skills.
• Excellent communication and interpersonal skills required.
• Must be able to communicate with physicians, senior administrators and office staff.
• Excellent organizational skills.
• Analytical abilities.
• Excellent written and oral presentation skills.
• Eagerness to learn new areas and work with little supervision.
• Good judgment.
• Ability to work with confidential materials and to juggle multiple tasks.

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 or
• Certified Coding Specialist (CCS) - American Health Information Management Association or National Association for Health Professionals - upon hire - Required or
• Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association - upon hire - Required or
• Certified Professional Coder (CPC) - American Academy of Professional Coders - upon hire - 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 receive an annual influenza vaccine. Learn more.

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