What are the responsibilities and job description for the COMPLIANCE CODING & BILLING ANALYST position at The University of Texas Rio Grande Valley?
Responsible for performing compliance reviews of billing and coding compliance functions and activities, compliance risk assessments, developing policies and procedures, and developing risk-based educational training to ensure compliance with federal/state laws and regulations and UTRGV policies. To review and analyze medical records, claims, and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements.
Description of Duties
General supervision from assigned supervisor.
Supervision Given
Direct supervision of assigned staff.
Required Education
Bachelor's degree in Business or Health related field from an accredited university.
Preferred Education
Bachelor's degree in Health Information Management, Health care related field, Regulatory Compliance or Project Management or a related field from an accredited university.
Licenses/Certifications
Certified Professional Medical Auditor (CPMA) by the American Health Information Management Association (AHIMA) or the American Academy Professional Coders (AAPC).
Required Experience
Two (2) years of related billing/coding and or auditing experience. Education may be substituted with experience on a one-to-one basis
Preferred Experience
Coding, auditing or quality assurance review experience. Bilingual (English/Spanish)
Equipment
Use of standard office equipment.
Working Conditions
Needs to be able to successfully perform all required duties. Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Work is performed primarily in a general office environment. Some travel and weekend work is required. UTRGV is a distributed institution, which may require presence at multiple locations throughout the Rio Grande Valley.
Other
Strong verbal, written and interpersonal communication skills. Strong analytical skills. Ability to multi-task in a fast-paced environment. Detail oriented with excellent organizational skills and high degree of integrity and confidentiality. Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner. Knowledge of state and federal laws applicable to healthcare and compliance industry. Knowledge of Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) coding. Knowledge of medical, billing and coding terminology and assignment of codes.
Physical Capabilities
N/A
Employment Category Full-Time Minimum Salary Commensurate with Experience Posted Salary Commensurate with Experience Position Available Date 04/02/2025 Grant Funded Position No If Yes, Provide Grant Expiration Date
Description of Duties
- Performs monitoring and compliance reviews of billing and coding compliance activities, associated risk assessments, developing policies and procedures and planning and developing risk-based educational training to ensure compliance with federal/state laws and regulations and UTRGV policies.
- Analyses and evaluates the effectiveness of compliance controls used by the area and its compliance with all applicable laws, policies, and procedures.
- Collects information and prepares billing compliance reports, provides supporting evidence, and conclusions, and makes recommendations for corrective measures on identified billing compliance.
- Analyzes data reports to identify issues and risk areas and makes recommendations as needed.
- Collaborates with the medical billing team to improve the quality of clinical documentation for compliance, billing, coding, and reimbursement processes.
- Reviews, assesses and analyzes medical records, coding, billing, claims, reimbursements and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements.
- Performs charge reviews comparing itemized bills to medical record documents to ensure appropriate charges.
- Performs reviews of electronic and manual documentation, coding, and billing systems. ·
- Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems.
- Conducts investigations of non-compliant, alleged breaches of policy to determine the cause and recommend a solution as well as preventative measures.
- Communicates findings to senior management and makes recommendations for preventive measures.
- Coordinates, evaluates and prepares quarterly reporting and verification through inspections and walk-throughs as assigned.
- Responsible for reviewing and preparing appropriate reports for the Physician's Advisory Council, Executive Compliance Committee, and UT System as needed.
- Develops and maintains risk compliance-related education and training materials and conducts training sessions.
- Monitor emerging changes and trends in the law, regulations and industry standards relating to compliance with and enforcement of applicable law and report impactful developments. ·
- Performs other duties as assigned.
General supervision from assigned supervisor.
Supervision Given
Direct supervision of assigned staff.
Required Education
Bachelor's degree in Business or Health related field from an accredited university.
Preferred Education
Bachelor's degree in Health Information Management, Health care related field, Regulatory Compliance or Project Management or a related field from an accredited university.
Licenses/Certifications
Certified Professional Medical Auditor (CPMA) by the American Health Information Management Association (AHIMA) or the American Academy Professional Coders (AAPC).
Required Experience
Two (2) years of related billing/coding and or auditing experience. Education may be substituted with experience on a one-to-one basis
Preferred Experience
Coding, auditing or quality assurance review experience. Bilingual (English/Spanish)
Equipment
Use of standard office equipment.
Working Conditions
Needs to be able to successfully perform all required duties. Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Work is performed primarily in a general office environment. Some travel and weekend work is required. UTRGV is a distributed institution, which may require presence at multiple locations throughout the Rio Grande Valley.
Other
Strong verbal, written and interpersonal communication skills. Strong analytical skills. Ability to multi-task in a fast-paced environment. Detail oriented with excellent organizational skills and high degree of integrity and confidentiality. Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner. Knowledge of state and federal laws applicable to healthcare and compliance industry. Knowledge of Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) coding. Knowledge of medical, billing and coding terminology and assignment of codes.
Physical Capabilities
N/A
Employment Category Full-Time Minimum Salary Commensurate with Experience Posted Salary Commensurate with Experience Position Available Date 04/02/2025 Grant Funded Position No If Yes, Provide Grant Expiration Date
