Faculty Coding, Billing & Reimbursement Compliance Auditor - Office of Institutional Compliance

Job description

Faculty Coding, Billing & Reimbursement Compliance Auditor - Office of Institutional Compliance

nGalveston, Texas, United States

nBusiness, Managerial & Finance

nUTMB Health

nRequisition #

nMinimum Qualifications:

nBachelor’s degree or equivalent and at least four years of relevant experience. Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) required.

nJob Summary:

nUtilize advanced skills necessary to audit documentation, coding, and reimbursement of professional, hospital/facility inpatient and outpatient billing. Ensure that documentation is complete and accurately reflects/supports the coded level of service. Audits will determine if the billed services are consistent with medical record documentation and in accordance with the appropriate third-party billing regulations and/or standards. Assist with the development and implementation of pre- and post-audit education as needed.

nJob Duties:

nnnUtilizes auditing software to select and conduct random or focused audits of professional and hospital/facility inpatient and outpatient billing based on determined criteria.

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nnConducts prospective and retrospective professional and inpatient and outpatient documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare/Medicaid Administrative Contractors (MACs), Medicare/Medicaid Recovery Audit Contractors (RACs), governmental audit entities, State regulations, and Institutional policies.

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nnApplies knowledge of professional, inpatient, and outpatient coding guidelines, and clinical documentation requirements to review billed services.

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nnMaintains a thorough understanding of CPT, ICD-10-CM, ICD-10-PCS, DRG, and HCPCS coding principles, governmental regulations, work plans, and third-party guidelines regarding documentation and/or billing compliance.

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nnDevelops and maintains a close working relationship with the Billing Compliance team to ensure documentation issues, patterns, and/or trends are identified and addressed by prospective compliance education in a timely manner.

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nnReviews providers’ and coding personnel’s coding accuracy and determines if the medical record is properly documented and if documentation supports the services billed.

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nnPerforms Quality Assurance (QA) reviews of other auditors within the Office of Institutional Compliance as required.

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nnAssists with analysis of data/reports from compliance monitoring activities to help identify trends, issues, risk areas, and opportunities for education and/or process improvement.

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nnPrepares and presents reports as needed.

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nnMonitors compliance with documentation standards and keeps current with changes in coding guidelines, compliance, reimbursement, and other regulatory updates; researches, investigates, evaluates, and identifies opportunities for improvement.

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nnHas a good understanding of all clinical information systems and data flow across the continuum of care.

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nnCompletes other job-related functions and special projects as assigned by the director.

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nnPerforms other duties as required.

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n nSalary Range:

nActual salary commensurate with experience.

nWork Schedule:

nMonday through Friday, 8 am to 5 pm, and as needed on occasion.

nEqual Employment Opportunity

nUTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

nCompensation

Worksite address

galveston, TX, 77554, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.