Faculty Coding, Billing & Reimbursement Compliance Auditor - Office of Institutional Compliance

University of Texas Medical Branch (UTMB)•Galveston, TX

9h•Onsite

About The Position

This role involves auditing the documentation, coding, and reimbursement of professional, hospital/facility inpatient and outpatient billing to ensure completeness and accuracy. The auditor will verify that documentation supports the coded level of service and that billed services align with medical record documentation and third-party billing regulations. The position also includes assisting with the development and implementation of pre- and post-audit education.

Requirements

Bachelor’s degree or equivalent
At least four years of relevant experience
Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) required

Responsibilities

Utilizes auditing software to select and conduct random or focused audits of professional and hospital/facility inpatient and outpatient billing based on determined criteria.
Conducts prospective and retrospective professional and inpatient and outpatient documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare/Medicaid Administrative Contractors (MACs), Medicare/Medicaid Recovery Audit Contractors (RACs), governmental audit entities, State regulations, and Institutional policies.
Applies knowledge of professional, inpatient, and outpatient coding guidelines, and clinical documentation requirements to review billed services.
Maintains a thorough understanding of CPT, ICD-10-CM, ICD-10-PCS, DRG, and HCPCS coding principles, governmental regulations, work plans, and third-party guidelines regarding documentation and/or billing compliance.
Develops and maintains a close working relationship with the Billing Compliance team to ensure documentation issues, patterns, and/or trends are identified and addressed by prospective compliance education in a timely manner.
Reviews providers’ and coding personnel’s coding accuracy and determines if the medical record is properly documented and if documentation supports the services billed.
Performs Quality Assurance (QA) reviews of other auditors within the Office of Institutional Compliance as required.
Assists with analysis of data/reports from compliance monitoring activities to help identify trends, issues, risk areas, and opportunities for education and/or process improvement.
Prepares and presents reports as needed.
Monitors compliance with documentation standards and keeps current with changes in coding guidelines, compliance, reimbursement, and other regulatory updates; researches, investigates, evaluates, and identifies opportunities for improvement.
Has a good understanding of all clinical information systems and data flow across the continuum of care.
Completes other job-related functions and special projects as assigned by the director.
Performs other duties as required.