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UT Health San Antonio · 1 month ago

Compliance Auditor, Billing and Coding Compliance

San Antonio, TX

Full-time

Onsite

Mid Level

3+ years exp

UT Health San Antonio is seeking a Compliance Auditor for their Billing and Coding Compliance department. This role involves overseeing auditing and monitoring activities to ensure compliance with federal and state regulations, developing educational materials, and effectively communicating audit findings.

EducationHealth CareHospitalMedicalProduct Research

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

Qualification

BillingCoding complianceHealth Information ManagementElectronic auditing toolsCPTDRG codingStateFederal lawsMicrosoft Office skillsCustomer servicePresentSelf-directResearch skillsTrack record with EPIC EHRCommunication skillsDetail orientedOrganizational skillsIntegrityConfidentialityCollaboration skills

Required

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

Bachelor's Degree required

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

Certified Professional Medical Auditor within 1 year

CPC, CCA, CCS / AHIMA, AAPC coding certification required

Preferred

Desired experience in dental coding and billing procedures

Certified Dental Billing Specialist (CDBS) or Certified Dental Coder (CDT) – Preferred

Benefits

Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas.

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.

Vision - Fully insured Vision Care benefits are offered by Superior Vision Services.

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).

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

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