Billing Edit Analyst

Req ID: 14663

Shift: Days

Employment Status: AF - Active - Regular - Full Time 

Job Summary

Under the supervision of the Billing Manager and Billing Supervisor, the individual is responsible for accurate coding of hospital outpatient services according to national coding guidelines.  Resolve NCCI edits that are holding patient claims from billing, by reviewing coding protocols.  Analyze data for ancillary departments and identify payor trends to prevent denials that delay reimbursement or cause rework within the Billing Department. In conjunction under the direction of Revenue Integrity the Billing Analyst contact hospital departments to resolve outstanding claims related to coding and charge entry edits as appropriate.   


Billing Edit Analyst is considered a subject matter expert for resolving all National Coding (NCCI) edits that impact timely submission of claims and reimbursement.  

Job Responsibilities

Performs tasks required to ensure the timely and accurate submission of insurance claims to all third party payors and documents billing activity in EPIC and Billing Editor. Tasks include:

  • Managing National Correct Coding Initiative (NCCI) edit work queues by insurance payors. 
  • Review and correct identified NCCI and other payer coding edits during the claim edit review process prior to submission to the payer.
  • Resolve edits by adding appropriate modifiers when required or takes other appropriate action.
  • Work with Revenue Integrity Manager to resolve charge edits as appropriate
  • Ensure all NCCI edits are resolved within 2 business days to ensure claims are submitted within 5 days from discharge date. 
  • Trend charges edits by ancillary department and collaborate with Revenue Integrity to resolve charge edits as appropriate.
  • Analyzes billing error and denial data to identify root causes. Executes on work plans to correct identified deficiencies.
  • Work with Patient Financial Services (PFS) and Revenue and Reimbursement to review coding denials and determine if case(s) should be appealed or resubmitted according to appropriate coding guidelines provided by the insurance payor.
  • Work closely with HIM on outpatient coding and utilizing 3M application as appropriate
  • Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Executes on work plans to adapt systems and processes to accommodate changes.
  • Updating account resolution in EPIC and promptly notifying Billing Management team if there are trends identified or patterns that may impact delay in payment. 


Required Licenses, Certifications, Registrations

CPC / CPCH Certification

Required Education and Experience

B.S. in Business, Finance, Accounting, or related field of study

Expertise in ICD-9, ICD-10, CPT-4, HCPCS coding, NCCI edits and modifier usage.

Claim edit coding experience in a healthcare setting 

Preferred Education, Experience & Cert/Lic

Preferred Licenses/certificates/registrations: CCS, RHI or RHITA

Additional Technical Requirements

  • General knowledge of payer requirements / regulations
  • Knowledge of hospital billing codes (Revenue, HCPCS, CPT, and understanding of EOB’s is required. 
  • Ability to resolve NCCI edits—understanding when to append a modifier or adjust a charge(s).
  • Understanding of CDM driven codes vs. HIM assigned codes.
  • Prior billing experience or general familiarity with the UB04 claims form.
  • Familiarity with or ability to research in the NCCI Policy Manual and Medicare Manuals.
  • Must adhere to HIPAA compliance.
  • Excellent interpersonal skills and the ability to communicate with payors and internal customers are a must
  • The ability to problem solves and analyzes billing data.
  • Demonstrate proficiency in relevant software applications, including Microsoft suite.
  • Requires a high degree of pro-active involvement and an analytical approach to appropriately maintain the integrity of sensitive, detailed information pertaining to patients, medical record keeping and financial transactions within EPIC and CHOP related sub-systems such as 3M.
  • Ability to manage time effectively

All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.

Children's Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children's Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).

Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.

VEVRAA Federal Contractor/Seeking priority referrals for protected veterans.  Please contact our hiring official with any referrals or questions.

CHOP Careers Contact 

Talent Acquisition

2716 South Street, 6th Floor

Philadelphia, PA 19146 

Phone: 866-820-9288 

Email:[email protected]



Childrens Hospital of Philadelphia
Full time
Philadelphia, Pennsylvania 19107, US