[Hiring] Coding/Compliance Denials Analyst @UT Southwestern Medical Center

Role Description

Develops outpatient coding education. Research complex outpatient coding denials. Conducts risk-based coding compliance audits and ad hoc audits of outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record and payer guidelines.

Qualifications

• 5 years of coding or relevant billing experience including but not limited to hospital outpatient encounters
• 5 years of experience in coding audit or quality review work including but not limited to outpatient encounters
• 1 year of experience preparing and delivering education as it relates to audit findings or regulatory guidance to coders and auditors
• Bachelor's Degree in relevant field preferred or combination of equivalent of education and experience

Requirements

• (CPC) CERT PROFESSIONAL CODER Upon Hire or
• (CPMA) Cert Prof Medical Auditor Upon Hire or
• (CEMC) Certified E/M Coder Upon Hire or
• (CPC-I) AAPC Approved Instructor Certification Upon Hire
• Employees working in Radiation Oncology/Imaging service lines must be registered as a Radiologic Technologist by the American Registry of Radiology Technologists (ARRT)

Benefits

• 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

Job Duties

• Develops outpatient coding education via spreadsheet.
• Research complex outpatient coding issues related to questions, inquiries, and investigations.
• Understands, interprets, and applies coding guidelines for risk-based audits.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS, AAPC and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (OPPS ICD-10-CM, and CPT updates) for outpatient coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
• Performs other duties as assigned.

Knowledge, Skills and Abilities

• Ability to audit coding of outpatient encounters consistently and accurately.
• Ability to create clear and concise audit reports and maintain productivity standards.
• Knowledge of medical terminology, ICD-10-CM, Evaluation/Management, Injections & Infusions, and CPT coding guidelines and methodologies.
• Knowledge of disease pathophysiology and drug utilization.
• Knowledge of APC, OCE, NCCI classification and reimbursement structures.
• Must be detail oriented and can work independently.
• Computer knowledge of MS Office.
• Must display excellent interpersonal skills.
• Ability to demonstrate initiative and discipline in time management and assignment completion.
• Ability to work in a virtual setting under minimal supervision.

Physical Requirements/Working Conditions

• Office Setting

Salary Information

Salary is commensurate with education, skills, and relevant experience.

Security and EEO Statement

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

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.