WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION
Required

• Education
  Graduate of an accredited nursing program, with a current license to practice in the state of Texas; RN.

• Experience
  10 years clinical experience as a Registered Nurse, including at least 5 to 7 years performing utilization review, charge audit, case management or denial/appeal functions in an acute care hospital. and

• Licenses and Certifications
  Principles of Managed Care, Medicare/Medicaid reimbursement required.

Preferred

• Experience
  Experience with Epic HB strongly preferred.

JOB DUTIES

• Monitors, tracks and coordinates all preparations for, and periodically, conduct audits requested by governmental and managed care payors, comparing clinical documentation to charges billed to identify any possible under/over charges; documents and sends audit results to payor organizations or external auditors for review and resolution as applicable; maintains communication with auditors and other relevant individual/organizations until all discrepancies are resolved.
• Develops and maintains all metrics for internally defined audits to identify under/over charges. Reports documented audit findings to appropriate departments.
• Performs monthly Quality Assurance checks to ensure account corrections are being performed within compliance guidelines. Results are presented to manager.
• Lead quarterly/periodic meetings with focused Revenue Integrity teams.
• Develop an overall approach for education to the various departments by directing periodic comprehensive reviews of charge capture practices.
• Assists departments with the charge reconciliation process. Works with all relevant hospital departments to provide timely education on how to correct or improve processes that have been found to be deficient.
• Works with various staff and departments such as Health Information Management, clinical nursing units, physicians and others to obtain the information necessary to perform account audits.

SECURITY AND EEO STATEMENT
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. To the extent this position requires the holder to research, work on, or have access to critical infrastructure as defined in Section 113.001(2) of the Texas Business and Commerce Code, the ability to maintain the security or integrity of the critical infrastructure is a minimum qualification to be hired and to continue to be employed in the position.

EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.