Certified Billing Compliance Specialist

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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
Assists the Senior Director of Billing Compliance with reviewing and analyzing billing processes and conducting auditing and monitoring to ensure compliance with applicable healthcare regulations.

What you will do

• Assists with compliance auditing process, including developing audit plans, conducting audits or managing the conduct of audits, reporting results and making recommendations for improvement.
• Promotes and supports professional and outpatient hospital billing compliance with billing and coding staff across the organization.
• Assists in the development of education & training programs.
• Monitors federal and local statutes and regulatory changes and makes recommendations for process improvement.
• Researches and analyzes compliance issues utilizing various publications including extensive use of the internet, the Federal Register, the Medicare Carriers Manual, and other industry publications; makes recommendations for process improvements, and monitors corrective action plans.
• Participates in assigned organizational committees.
• Conducts other projects and assignments as assigned.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Healthcare, business, communications, education law or related field. Preferred

Experience Qualifications

• At least five (5) years Related experience required
• Professional coding and billing experience preferred
• Hospital/facility coding (outpatient or inpatient) experience in addition to professional coding and billing experience preferred
• Experience with Auditing professional coding and billing preferred
• Experience with behavioral health coding and billing preferred

Skills and Abilities

• Behavioral health coding and billing experience highly desirable (Preferred proficiency)
• Billing office experience desirable (Preferred proficiency)

Licenses and Certifications

• Certified Professional Coder (CPC) - American Academy of Professional Coders - upon hire - Required or
• Certified Outpatient Coder (CPC-H) - American Academy of Professional Coders - upon hire - Required or
• Certified Coding Specialist (CCS) - American Health Information Management Association - upon hire - Required or
• Certified Coding Specialist-Physician-Based (CCS-P) - American Health Information Management Association - 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 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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