Revenue Integrity Educator III

The University of Texas Southwestern Medical Center; Dallas, Northern (TX, KY); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Healthcare benefits

PTO & Holidays

Tuition Reimbursement

Retirement Programs

Job summary

UT Southwestern Medical Center seeks a billing integrity professional to lead and deliver coding, billing and compliance training under minimal supervision. The role includes pre-bill review, audits, and collaboration with MSRDP leadership on risk areas and corrective actions.

The ideal candidate has 6 years in professional billing with coding/auditing experience and holds CPC, CCS, CMC, and CPMA certifications; a Bachelor's degree is preferred.

Qualifications

• 6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities
• Education: High School Diploma or equivalent; Bachelor's degree preferred
• Licenses and Certifications: CPC, CCS, CMC, CPMA upon hire; RN upon hire preferred

Responsibilities

• Serves as a professional billing integrity project leader, developing and delivering coding, billing and compliance trainings under minimal supervision.
• Performs post-onboarding pre-bill review of professional charges and provides feedback to providers.
• Conducts independent reviews of medical record documentation to support coding and reduce compliance risk.
• Researches policy questions to ensure payer and government regulation compliance and optimal reimbursement.
• Completes audits and education with the Compliance Office and monitors action plans to ensure improvements.

Skills

Billing

Auditing

Compliance

Training

Education

High School Diploma

Bachelor's Degree

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

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.

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

• Experience
• 6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities

• Licenses and Certifications
• (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

Preferred

• Education
• Bachelor's Degree

• Licenses and Certifications
• (RN) REGISTERED NURSE Upon Hire

JOB DUTIES

• 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. 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.

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

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.