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- 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.
- 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
- 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. Advanced
Compliance Coding - San Antonio, United States - UT Health San Antonio
Description
Job Summary:
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.
Job Duties:
Knowledge, Skills, and Abilities:
Bachelors degree is 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.
Licenses/Certifications:
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.