COMPLIANCE CODING AND BILLING ANALYST

University of Texas Rio Grande Valley • Mcallen, TX

79d

About The Position

Responsible for performing compliance reviews of billing and coding compliance functions and activities, compliance risk assessments, developing policies and procedures, and developing risk-based educational training to ensure compliance with federal/state laws and regulations and UTRGV policies. To review and analyze medical records, claims, and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements.

Requirements

• Bachelor's degree in Business or Health related field from an accredited university.
• Two (2) years of related billing/coding and or auditing experience. Education may be substituted with experience on a one-to-one basis.
• Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) by the American Health Information Management Association (AHIMA) or the American Academy Professional Coders (AAPC).

Nice To Haves

• Bachelor's degree in Health Information Management, Health care related field, Regulatory Compliance or Project Management or a related field from an accredited university.
• Coding, auditing or quality assurance review experience.
• Bilingual (English/Spanish)

Responsibilities

• Performs monitoring and compliance reviews of medical billing and coding compliance activities, associated risk assessments, developing policies and procedures and planning and developing risk-based educational training to ensure compliance with federal/state laws and regulations and UTRGV policies.
• Analyses and evaluates the effectiveness of compliance controls used by the area and its compliance with all applicable laws, policies, and procedures.
• Collects information and prepares billing compliance reports, provides supporting evidence, and conclusions, and makes recommendations for corrective measures on identified billing compliance.
• Analyzes data reports to identify issues and risk areas and makes recommendations as needed.
• Collaborates with the medical billing team to improve the quality of clinical documentation for compliance, billing, coding, and reimbursement processes.
• Reviews, assesses and analyzes medical records, coding, billing, claims, reimbursements and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements.
• Performs charge reviews comparing itemized bills to medical record documents to ensure appropriate charges.
• Performs reviews of electronic and manual documentation, coding, and billing systems.
• Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.
• Conducts investigations of non-compliant, alleged breaches of policy to determine the cause and recommend a solution as well as preventative measures.
• Communicates findings to senior management and makes recommendations for preventive measures.
• Coordinates, evaluates and prepares quarterly reporting and verification through inspections and walk-throughs as assigned.
• Responsible for reviewing and preparing appropriate reports for the Physician's Advisory Council, Executive Compliance Committee, and UT System as needed.
• Develops and maintains risk compliance-related education and training materials and conducts training sessions.
• Monitor emerging changes and trends in the law, regulations and industry standards relating to compliance with and enforcement of applicable law and report impactful developments.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Educational Services
• Education Level: Bachelor's degree