Revenue Integrity Auditor & Educator III

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 No. 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! 

JOB SUMMARY
UT Southwestern Medical Center has a new opportunity available for a Revenue Integrity Educator III AKA Revenue Integrity Auditor & Educator. This position works under minimal supervision to develop and conduct individual or group presentations on coding, billing and compliance topics, based on new regulatory and professional coding industry information; pre-bill professional charge review findings; University-identified risk areas, or special projects requested by MSRDP leadership. 

Revenue Cycle Management Support: Research coding, documentation and reimbursement inquiries submitted by physicians, clinical departments, or revenue cycle management to ensure compliance with specific payer and/or government regulations and optimum reimbursement. Prepares timely responses based on research outcome. Conduct quality assurance reviews to ensure coding and billing practices are accurate, compliant with regulations, and aligned with university policies and Revenue Cycle Management guidelines. Reviews charges for any service line, ensures timely resolution, assists Supervisor with broader monitoring. Monitors team queues regularly, ensures team-wide timely resolution, performs quality assurance reviews.

New Provider Education: Conduct standardized education for new providers (physicians, advanced practice providers, and other professional practitioners) for Internal Medicine, Pediatrics, Emergency Medicine, Radiology, PM&, R, Neurology, Psychiatry. Perform pre-bill reviews of professional charges and follow up with new providers to ensure accurate coding and documentation practices. Performs post-onboarding pre-bill review of professional charges and follow-up with new providers to confirm understanding documentation requirements to promote billing compliance. Independently conduct reviews, apply critical thinking, develop detailed action plans for risk mitigation. Independently develops, updates, and conducts onboarding and specialty-specific training.

Clinical Department Education: Develop and conduct individual or group physician education presentations on coding, billing compliance guidelines, audit findings or internal reporting. Develop comprehensive content for presentations, including key concepts, regulations, case studies and practical examples.

Billing Compliance Reviews: Conduct independent reviews on adequacy of medical record documentation to support the procedure, modifier and diagnosis coding of any service line billed by any supported physicians, practitioners or billing staff, or areas that may pose a compliance risk and develop recommended solutions/action plans, which may include revised workflows and/or education. Serves as a professional billing integrity project leader, for all service lines, under minimal supervision. Leads project independently with minimal supervision.

• Work Schedule: Monday through Friday, 8:00 a.m. to 5:00 p.m. Additional scheduling details will be discussed during the interview process.
• Work From Home (WFH): This is a WFH position opportunity. Preference will be given to candidates that reside in Texas.    

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
  High School Diploma or equivalent 
   

• Experience
  6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities 
   

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER Upon Hire or 
  (CCS) CERT CODING SPECIALIST Upon Hire or 
  (CMC) CERT MEDICAL CODER Upon Hire or 
  (CPMA) Cert Prof Medical Auditor within 1 Year 
   

Preferred

• Education
  Bachelor's Degree 
   

• Licenses and Certifications
  (RN) REGISTERED NURSE Upon Hire 
   

JOB DUTIES

• Serves as a professional billing integrity project leader, for all service lines, under minimal supervision, to develop and conduct individual or group presentations on coding, billing and compliance topics, based on new regulatory and/or professional coding industry information; pre-bill professional charge review findings; University-identified risk areas, or special projects requested by MSRDP leadership. This may include medical record audits, invoice analysis, and review of internal reports (e.g., charge analyzer, Code Correct) denials, external audit findings, etc. Responsible for the development and deployment of any quality improvement or corrective action plans required. Monitors for intended improvements or necessary alterations in action plans and reports progress to Supervisor and/or Manager.
• Develops and conducts standardized and/or specialty-driven new provider coding and compliance training ("onboarding") for any service line, for physicians, advanced practice providers and other professional practitioners, in an individual or group setting. Ensures onboarding schedule is current and covered by team members, and regularly reviews onboarding platform and processes, working with Supervisor and team members to revise when indicated.
• Performs post-onboarding pre-bill review of professional charges, for any service line. Provides necessary feedback and follow-up with new providers to confirm understanding of procedure, modifier and diagnosis code assignment, as well as documentation requirements (teaching physician, working with advanced practice providers, etc.) to promote billing compliance. Assists Supervisor with ensuring any pending charges are reviewed and released in a timely manner according to MSRDP standards.
• Conduct independent reviews on adequacy of medical record documentation to support the procedure, modifier and diagnosis coding of any service line billed by any supported physicians, practitioners or billing staff, or areas that may pose a compliance risk and develop recommended solutions/action plans, which may include revised workflows and/or education. These reviews will require the application of critical thinking skills to summarize findings and develop action plans for risk mitigation. These reviews may be requested by MSRDP leadership, department/division leadership, medical residency coordinators, and others.
• Researches coding, documentation and reimbursement policy questions or problems submitted by physicians, practitioners, supported-departments, billing staff and others, to ensure compliance with specific payer and/or government regulations and optimum reimbursement. Prepares timely responses based on research outcome. Escalate issues to Supervisor or Manager, when indicated.
• In coordination with the Compliance Office, support and/or conduct Billing Compliance risk-based audits and resulting education.
• Completes charge review and follow-up EPIC work queue assignments, for any service line, within department timeliness standards, under minimal guidance of the supervisor. Assists supervisor in monitoring team work queues regularly to ensure timely resolution of charges/questions. Conducts quality assurance reviews for internal or contractor staff to verify the coding or other work is consistent and supported by regulations, University guidelines and/or MSRDP Medicine Audit Plan; with reporting and education, when indicated.
• Provides training to new internal or contractor staff on the use of audit software, EPIC, internal audit plan, work queue assignments, etc. as needed.
• Performs other duties, as assigned.

Knowledge, Skills and Abilities

• Must be able to work independently, or as a collaborating team member, to address a variety of complex issues in a timely fashion.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• Work requires ability to interact effectively with various levels of faculty and staff to ensure billing/coding rules are met or exceeded.
• Work requires flexibility, strong ability to organize tasks and prioritize workload
• Work requires knowledge of CPT, HCPCS and ICD-9-CM coding systems, as well as medical record documentation and accepted billing/coding standards.
• Work requires strong verbal and written communication skills
• Work requires the ability to analyze medical records, billing history, payer rules and other data to validate regulatory compliance and organizational billing integrity
• Work requires the ability to evaluate data and develop action plans and/or educational presentations
• Work requires the ability to interact effectively, professionally and respectfully with all levels of the organization
• Work requires the basic skills to use Microsoft Office (Word, Excel, PowerPoint)
• Work requires the individual to be detail-oriented and able to manage a high volume of tasks with follow-through to completion

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Working Conditions

• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

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.

EEO
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.