May 20, 2024

Compliance Coding & Billing Auditor

  • UT Health San Antonio
  • San Antonio, TX, USA
Full Time (CPC) Certified Professional Coder (CPC-A) Certified Professional Coder - Apprentice (CRC) Certified Risk Adjustment Coder (CPB) Certified Professional Biller (CPMA) Certified Professional Medical Auditor

Job Description

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, developing 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:

  1. Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department.
  2. Performs audits of electronic and manual documentation, coding, and billing systems.
  3. Conducts close-out meetings with senior management of audited departments.
  4. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines and ensure staff is kept informed.
  5. Create audit schedules and manage workflows to adhere to the audit schedule.
  6. Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc.
  7. Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations.
  8. Performs charge audits by comparing itemized bill to medical record documentation to ensure appropriate charging.
  9. Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.
  10. Serve as a point of contact for reports of billing compliance concerns or potential issues. Respond timely and professionally.
  11. 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.
  12. Collaborate broadly across business and operational areas within the university to analyze and assess business processes, data, and risk controls.
  13. 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.
  14. Analyze data/reports to identify and address trends, issues, and risk areas.
  15. Participates in the development of voluntary disclosures and repayments to federal and state agencies.
  16. Performs all other duties as assigned.

Qualifications:

  1. Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner. Advanced
  2. 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
  3. 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
  4. Knowledge of treatment protocols, medical and surgical procedures and other healthcare practices. Intermediate
  5. Knowledge of state and federal laws applicable to healthcare and compliance industry. Intermediate
  6. Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) coding knowledge. Intermediate
  7. Ability to self-direct and prioritize work. Intermediate
  8. Detail oriented with excellent organizational skills and high degree of integrity and confidentiality. Advanced
  9. Advanced computer database and Microsoft Office software skills. Advanced
  10. Excellent customer service skills and strong willingness to take initiative. Advanced
  11. Strong verbal, written and interpersonal communication skills. Advanced
  12. Ability to present to small or large groups. Intermediate
  13. Ability to commute to various UTHSA facility locations within a 50-mile radius of the University Campus. Intermediate
  14. Established track record working with EPIC EHR system. Advanced

EDUCATION:

  • Bachelor's degree required.
  • Graduate level degree or will have acquired professional experience working with an auditing/consulting company preferred

EXPERIENCE:

  • Three (3) to five (5) years of experience working in a professional fee clinic and teaching hospital (inpatient and outpatient) settings.
  • Two (2) years of auditing experience using EPIC EHR system, and use of an electronic auditing tool like MDAudit.

LICENSES:

  • Must possess a valid coding certification from a recognized certifying agency such as AHIMA and/or AAPC. 
  • Must become a Certified Professional Medical Auditor within one year of employment. 

Required Skills:

Coding, auditing or quality assurance review experience. Oncology audit experience is highly desirable. Experience working in an academic medical center, hospital, or oncology clinic is highly desirable. Hospital charging knowledge. Three (3) to five (5) years of experience working in a professional fee clinic and teaching hospital (inpatient and outpatient) settings. Two (2) years of auditing experience using EPIC EHR system, and use of an electronic auditing tool like MDAudit.

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. 
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. Life Employees receive $40,000 of group term life insurance and $40,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates. 
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 plus three floating holidays, which can be used anytime during the fiscal year.
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. 
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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.

Required Experience Level

Intermediate Level

Minimum Education

Bachelor's Degree

Minimum Experience Required

4-6 years

Applicant Location

US residents only