Revenue Integrity Educator III

UT Southwestern Medical Center • Dallas, TX

10h • Onsite

About The Position

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. 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.

Requirements

• High School Diploma or equivalent
• 6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities
• (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

Nice To Haves

• Bachelor's Degree
• (RN) REGISTERED NURSE Upon Hire

Responsibilities

• 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.
• 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.
• Performs post-onboarding pre-bill review of professional charges, for any service line.
• 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.
• 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.
• 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.
• 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.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED