[Hiring] Revenue Integrity Auditor & Educator II @UT Southwestern Medical Center

Role Description

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 are 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.
  • Prepare 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.
  • Perform 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.

Qualifications

• High School Diploma or equivalent.
• 5 years experience in a professional billing environment with emphasis on coding, auditing, and compliance responsibilities.
• (CPC) CERT PROFESSIONAL CODER Upon Hire or (CCS) CERT CODING SPECIALIST Upon Hire or (CMC) CERT MEDICAL CODER Upon Hire.
• Associate's Degree or two years of college (preferred).
• (CPMA) Cert Prof Medical Auditor Upon Hire (preferred).

Requirements

• Serves as a professional billing integrity leader, under supervision of Sr. Professional Billing Integrity Educator or Supervisor.
• Conducts standardized new provider coding and compliance training ("onboarding") for physicians, advanced practice providers, and other professional practitioners.
• Performs post-onboarding pre-bill review of professional charges and follow-up with new providers.
• Conducts increasingly independent reviews on adequacy of medical record documentation.
• Research coding, documentation, and reimbursement policy questions or problems submitted by physicians, practitioners, supported-departments, billing staff, and others.
• 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.
• Assists with training for contractor staff on the use of audit software, EPIC, internal audit plan, work queue assignments, etc.
• Performs other duties, as assigned.

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.

Company Description

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.