Revenue Integrity Auditor and Educator

Title: Revenue Integrity Auditor & Educator Location: Dallas United States Location Type: Hybrid Job Number: 250000SY Category: Insurance/Billing Job Description: 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 number 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 The Revenue Integrity Educator II AKA Revenue Integrity Auditor & Educator position works under minimal supervision to develop and conduct individual or group presentations on coding, billing, and compliance topics. The duties for this position will include but is not limited to the following: 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. 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 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 documentation and billing compliance reviews to assess the adequacy of medical record documentation and appropriate use of procedure, modifier, and diagnosis codes. Summarize audit outcomes and provide education as needed. • Shift: Monday through Friday, 8am-5pm. Additional details shall be discussed as part of the interview process. • Work From Home (WFH): This is a WFH opportunity. Candidates must live in Texas. Additional details shall be discussed as part of the interview process. 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 or • Experience 5 years of experience in a professional billing environment with emphasis on coding, auditing and compliance responsibilities or • Licenses and Certifications (CPC) CERT PROFESSIONAL CODER Or (CCS) CERT CODING SPECIALIST Or (CMC) CERT MEDICAL CODER Preferred • Education Associate's Degree or Two years of college is desired. • Licenses and Certifications (CPMA) Cert Prof Medical Auditor Upon Hire JOB DUTIES • Serves as a professional billing integrity leader, under supervision of Sr. Professional Billing Integrity Educator or Supervisor, 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. Assists Sr. Professional Billing Integrity Educator or Supervisor with development and deployment of any action plans required. • Conducts standardized new provider coding and compliance training ("onboarding") for physicians, advanced practice providers and other professional practitioners, in two or more service lines/divisions. Training may be conducted in an individual or group setting. • Performs post-onboarding pre-bill review of professional charges and follow-up with new providers to confirm understanding of procedure, modifier and diagnosis code assignment, as well as, documentation requirements to promote billing compliance. Supporting two or more service lines, with supervision by Sr. Professional Billing Integrity Educator or Supervisor. • Conducts increasingly independent reviews on adequacy of medical record documentation, to support the procedure, modifier and diagnosis coding of evaluation and management (E&M) services and low-moderate complexity diagnostic/therapeutic services, billed by physicians, practitioners or billing staff, in two or more service areas. Working with Sr. Professional Billing Integrity Educator or Supervisor, develops reports that summarize outcomes. Provides input on recommended corrective action plans. • Research 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. Assist Senior Billing Integrity Educator and/or supervisor with responses. Escalates issues beyond their scope to Senior Billing Integrity Educator, Supervisor or Manager. • In coordination with the Compliance Office, support and/or conduct Billing Compliance risk-based audits. • Complete charge review and follow-up EPIC work queue assignments, within department timeliness standards, under guidance of the Senior Billing Integrity Educator or supervisor. Assists with 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. • Assists with training for contractor staff on the use of audit software, EPIC, internal audit plan, work queue assignments, etc. as needed. • Performs other duties, as assigned. 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 Statement 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. Apply tot his job