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Coding-Billing & Reimbursement Auditor - Office of Institutional Compl

Company: University of Texas Medical Branch
Location: Galveston
Posted on: March 19, 2020

Job Description:

Min QualificationsAssociates degree or equivalent. Three years related experience. Must be certified as Certified Professional Coder (CPC/CPC-H) by the American Academy of Professional Coders or be a Registered Health Information Administrator (RHIA), or a Certified Coding Specialist (CCS/CCS-P) by the American Health Information Management Association.Job Description:Utilize advanced skills necessary to audit documentation, coding, and reimbursement of hospital and physician billing. Audits will determine if billed services are consistent with medical record documentation, and in accordance with the appropriate third party billing regulations and/or standards.Salary RangeActual salary commensurate with experience.Specific Job Related Duties

  • Utilizes auditing software to select and conduct random or focused audits of providers and hospital/facility billing based upon determined criteria.
  • Conducts prospective and retrospective inpatient and outpatient documentation audits to confirm compliance with documentation and billing rules and regulations set forth by various payers, including but not limited to the Centers for Medicare and Medicaid Services (CMS), Medicare Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Medicaid, State regulations, and Institutional policies.
  • Maintains a thorough understanding of CPT, ICD-10-CM, and HCPCS coding principles, governmental regulations, 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 promptly 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.
  • Regularly produces and delivers various reports to Billing Compliance management and Revenue Cycle Operations (RCO) as necessary.
  • Performs Quality Assurance (QA) reviews of other auditors within the Office of Institutional Compliance as required.
  • Monitors compliance with documentation standards; researches, investigates, evaluates and identifies opportunities for improvement.
  • Adheres to internal controls and reporting structure.Work ScheduleMonday through Friday, 8am to 5pm.Preferred EducationBachelor's Degree.Preferred Work ExperienceFive years experience.Closing Statement#profEqual Employment OpportunityUTMB Health strives to provide equal opportunity employment without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities. Req id: 69194

Keywords: University of Texas Medical Branch, Galveston , Coding-Billing & Reimbursement Auditor - Office of Institutional Compl, Accounting, Auditing , Galveston, Texas

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