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

Role Description

UT Southwestern Medical Center has a new opportunity available for a Revenue Integrity Educator III AKA Revenue Integrity Auditor & Educator. 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.

• 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.
  • Review charges for any service line, ensure timely resolution, assist Supervisor with broader monitoring.
  • Monitor team queues regularly, ensure team-wide timely resolution, perform quality assurance reviews.
• 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.
  • Independently conduct reviews, apply critical thinking, develop detailed action plans for risk mitigation.
  • Independently develop, update, and conduct onboarding and specialty-specific training.
• 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 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.
  • Develop recommended solutions/action plans, which may include revised workflows and/or education.
  • Serve as a professional billing integrity project leader, for all service lines, under minimal supervision.

Qualifications

• High School Diploma or equivalent.
• 6 years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities.
• (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: Bachelor's Degree.
• Preferred: (RN) REGISTERED NURSE Upon Hire.

Requirements

• Must be able to work independently, or as a collaborating team member, to address a variety of complex issues in a timely fashion.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• Work requires ability to interact effectively with various levels of faculty and staff to ensure billing/coding rules are met or exceeded.
• Work requires flexibility, strong ability to organize tasks and prioritize workload.
• Work requires knowledge of CPT, HCPCS and ICD-9-CM coding systems, as well as medical record documentation and accepted billing/coding standards.
• Work requires strong verbal and written communication skills.
• Work requires the ability to analyze medical records, billing history, payer rules and other data to validate regulatory compliance and organizational billing integrity.
• Work requires the ability to evaluate data and develop action plans and/or educational presentations.
• Work requires the ability to interact effectively, professionally and respectfully with all levels of the organization.
• Work requires the basic skills to use Microsoft Office (Word, Excel, PowerPoint).
• Work requires the individual to be detail-oriented and able to manage a high volume of tasks with follow-through to completion.

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

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.