Compliance Auditor, Billing and Coding Compliance

Job Description

The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.

Responsibilities

• Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department.
• Performs audits of electronic and manual documentation, coding, and billing systems.
• Conducts close-out meetings with senior management of audited departments.
• Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines and ensure staff is kept informed.
• Create audit schedules and manage workflows to adhere to the audit schedule.
• Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc.
• Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations.
• Performs charge audits by comparing itemized bill to medical record documentation to ensure appropriate charging.
• Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems. Serve as a point of contact for reports of billing compliance concerns or potential issues.
• Respond timely and professionally. Monitor emerging changes and trends in the law, regulations and industry standards relating to compliance with and enforcement of applicable law and report impactful developments.
• Performs research, as needed.
• Collaborate broadly across business and operational areas within the university to analyze and assess business processes, data, and risk controls.
• Performs medical record audits of documentation, coding and billing for technical and professional services, 340-B Pharmacy, grant-funded research, risk adjustment, non-physician practitioner documentation (including incident-to guidelines, teaching physician guidelines, dental, and other areas as identified.)
• Maintains communication with auditors and other relevant individuals/organizations until all identified discrepancies are resolved.
• Analyze data/reports to identify and address trends, issues, and risk areas.
• Participates in the development of voluntary disclosures and repayments to federal and state agencies.
• Performs all other duties as assigned.
  
  

Qualifications

• Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner.
• Advanced Demonstrates in-depth knowledge regarding professional/hospital coding, billing and revenue cycle, research grant funding, as well as Health Information Management (HIM) operations.
• Has a working knowledge of electronic auditing tools like MDAudit.
• Advanced Highly organized with ability to independently analyze, conduct research and present findings/relay information to other departments/teams on various compliance, documentation, coding and finance-related topics.
• Advanced Knowledge of treatment protocols, medical and surgical procedures and other healthcare practices.
• Intermediate Knowledge of state and federal laws applicable to healthcare and compliance industry.
• Intermediate Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) coding knowledge.
• Intermediate Ability to self-direct and prioritize work.
• Intermediate Detail oriented with excellent organizational skills and high degree of integrity and confidentiality.
• Advanced computer database and Microsoft Office software skills.
• Advanced Excellent customer service skills and strong willingness to take initiative. Advanced Strong verbal, written and interpersonal communication skills. Advanced
• Ability to present to small or large groups.
• Intermediate Ability to commute to various UTHSA facility locations within a 50-mile radius of the University Campus.
• Intermediate Established track record working with EPIC EHR system.
  
  

EDUCATION

• Bachelor's Degree required.
  
  

Experience

• Three (3) to five (5) years of experience working in a professional fee clinic and teaching hospital (inpatient and outpatient) settings.
• Desired experience in dental coding and billing procedures.
  
  

LICENSES & CERTIFICATIONS

• Certified Professional Medical Auditor within 1 year.
• CPC, CCA, CCS / AHIMA, AAPC coding certification required.
• Certified Dental Billing Specialist (CDBS) or Certified Dental Coder (CDT) – Preferred.
  
  

Required Skills

Three (3) to five (5) years of experience working in a professional fee clinic and teaching hospital (inpatient and outpatient) settings.

About Us

Benefits Overview

UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.

Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.

Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.

Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.

Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.

FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.

Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.

Time Off - A generous leave program offers multiple paid leave options:

• Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
• Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
• Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
• Holidays: 12 set paid holidays each year.
  
  

Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.

EEO Statement

UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.