Billing Compliance Analyst II - Medicine and Ancillary Front End
Categories: Professional, Insurance / Billing
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.
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.