Billing Compliance Analyst II - Medicine & Ancillary Front End
Department: MSRDP Front End Revenue Cycle
Full/Part Time/PRN: Full-Time
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
High school diploma or equivalent; additional education preferred. Five (5) years of professional experience in physician billing or coding are required.
Certification as one of the following: Registered Record Administrator (RRA), Registered Health Information Administrator (RHIA), Advanced Records Technician (ART) or
Licensure as a Registered Nurse by the Texas Board of Nursing or
Certified as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Certified Medical Coder (CMC). Consideration can be given for related specialized functional coding certifications.
Plans and conducts annual clinical department billing compliance audits by selecting statistically valid sample of invoices, collecting documents, analyzing standards, completing tally sheets, and reviewing charts to invoices.
Ensures statistical selections are validated and audit tally sheets are accurate.
Prepares departmental summaries based on billing compliance audit and presents findings to department staff, Billing Compliance Officer, and Billing Compliance Advisory Committee.
Identifies risk areas requiring additional review by evaluating statistical reports, summaries, and other information pertaining to billing compliance; performs focused audits in addition to annual audit when necessary.
Develops corrective action plans to assist in resolving problems related to billing compliance.
Assists clinical departments with revisions to departmental compliance plans and compliance training.
Investigates telephone calls, written notes, and other reports of possible noncompliance to determine university's exposure to corrective action by payers.
Provides Medicare program and claim coding analysis by contacting Medicare representatives, attending seminars, and completing summaries for clinical department requesting information; ensures information obtained from carrier is documented and validated.
Maintains expertise in accepted coding, documentation, and compliance procedures by initiating contact with other organizations and associations, attending training workshops, and self-study of reference materials.
Documents findings by writing summary forms, constructing opinion letters, and maintaining audit files.
Interacts with Billing Compliance Committee to identify and address compliance needs, make recommendations for corrective and/or disciplinary action, and perform risk assessments of departmental coding and charge capture activities.
Assists with supporting assigned centralized medicine departments by performing billing compliance audits, new hire onboarding, billing integrity via EPIC work queues, email direction for providers and staff, on coding, reimbursement policy and compliance issues; and special projects requiring an experienced auditor level of knowledge. Expectations to complete approximately 60 provider audits per quarter.
Internal Medicine (all divisions), as well as, backing up other departments when there is a high volume of audits assigned to the team. This includes any follow up provider and/or billing staff education necessary as a result of audit findings, or provider request. BCA II also review and rebut, where indicated, audits completed by Core Compliance within the assigned department/division(s). This number varies but can be as many as 30 per quarter. Each BCA II is also charged with summarizing the quarter's audit results and sending summaries to the department or division compliance officer, including any remediation and education recommendations. Issues needing correction or re¿education of the billing team are also summarized and reported to the billing manager(s).
Responsible to provide new hire onboarding for their assigned department(s), as well as, providing backup for other team members as needed. Heaviest onboarding season is June, September, and the 2+ hour sessions can be as often as 3/week. The BCA II lends their coding and compliance expertise to support the billing staff, as complex coding and compliance questions are submitted via EPIC WQs and emails. Each analyst is expected to meet a 2 business day response to these WQ issues, so as not to increase charge lags.
The BCA II is called upon, as needed, to provide education, both one¿on¿one and for groups, on topics requested by and to the billing team; new residents/fellows; clinical department leadership and faculty.
Special projects vary and can include performing QA on coding vendors; mentoring new BCA staff; analayzing charge data and coding patterns with related documentation to determine accurate level of service/coding with reports and/or presentations to the requesting department/provider/MSRDP leadership.
Performs other duties as assigned.
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.