Lead Coding & Reimbursement Compliance Auditor

The University of Texas Medical Branch; Galveston (TX); On-site; USD 70,000 - 110,000; Full time

Job summary

The University of Texas Medical Branch in Texas seeks an experienced Healthcare Auditor to verify documentation, coding, and reimbursement across professional and inpatient/outpatient services. You will apply CPT/ ICD-10 guidelines and support education for auditing staff.

Responsibilities include selecting audits with auditing software, ensuring CMS/compliance standards are met, and presenting findings to leadership while staying current with regulatory updates.

Qualifications

• Bachelor’s degree or equivalent and 4+ years of relevant experience.
• Certified Coding Specialist (CCS) by AHIMA required.
• Understanding CPT, ICD-10-CM/PCS, DRG, and HCPCS coding principles.

Responsibilities

• Audits will determine if the billed services are consistent with medical record documentation and in accordance with third-party billing standards.
• Utilizes auditing software to select and conduct random or focused audits of professional and hospital/facility billing.
• Applies knowledge of professional, inpatient, and outpatient coding guidelines to review billed services.
• Maintains understanding of CPT, ICD-10-CM, ICD-10-PCS, DRG, and HCPCS coding principles and governmental regulations.
• Develops and maintains relationships with Billing Compliance to address documentation issues through education.
• Reviews providers' and coding personnel’s coding accuracy and determines if the medical record supports services billed.
• Performs QA reviews of other auditors within the Office of Institutional Compliance.
• Analyzes data/reports to identify trends and opportunities for improvement.

Skills

Auditing

CMS compliance

Coding accuracy

Education

Bachelor's degree or equivalent

AHIMA CCS certification

Job description

The University of Texas Medical Branch in Texas seeks an experienced Healthcare Auditor to verify documentation, coding, and reimbursement across professional and inpatient/outpatient services. You will apply CPT/ ICD-10 guidelines and support education for auditing staff.

Responsibilities include selecting audits with auditing software, ensuring CMS/compliance standards are met, and presenting findings to leadership while staying current with regulatory updates.