Compliance Auditor

The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.

• Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner. 
• Advanced Demonstrates in-depth knowledge regarding professional/hospital coding, billing and revenue cycle, research grant funding, as well as Health Information Management (HIM) operations. 
• Has a working knowledge of electronic auditing tools like MDAudit. 
• Advanced Highly organized with ability to independently analyze, conduct research and present findings/relay information to other departments/teams on various compliance, documentation, coding and finance-related topics. 
• Advanced Knowledge of treatment protocols, medical and surgical procedures and other healthcare practices. 
• Intermediate Knowledge of state and federal laws applicable to healthcare and compliance industry. 
• Intermediate Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) coding knowledge. 
• Intermediate Ability to self-direct and prioritize work. 
• Intermediate Detail oriented with excellent organizational skills and high degree of integrity and confidentiality. 
• Advanced computer database and Microsoft Office software skills. 
• Advanced Excellent customer service skills and strong willingness to take initiative. Advanced Strong verbal, written and interpersonal communication skills. Advanced 
• Ability to present to small or large groups. 
• Intermediate Ability to commute to various UTHSA facility locations within a 50-mile radius of the University Campus. 
• Intermediate Established track record working with EPIC EHR system. 

EDUCATION

• Bachelor's Degree required.

EXPERIENCE

• Three (3) to five (5) years of experience working in a professional fee clinic and teaching hospital (inpatient and outpatient) settings.
• Desired experience in dental coding and billing procedures.

LICENSES & CERTIFICATIONS

• Certified Professional Medical Auditor within 1 year.
• CPC, CCA, CCS / AHIMA, AAPC coding certification required.
• Certified Dental Billing Specialist (CDBS) or Certified Dental Coder (CDT) – Preferred.

• Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. 
• Performs audits of electronic and manual documentation, coding, and billing systems. 
• Conducts close-out meetings with senior management of audited departments. 
• Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines and ensure staff is kept informed. 
• Create audit schedules and manage workflows to adhere to the audit schedule. 
• Develop methods to effectively communicate information through presentations, graphs, reports, educational materials, etc. 
• Develop, establish, and review policies and objectives consistent with those of the organization to ensure efficient departmental operations. 
• Performs charge audits by comparing itemized bill to medical record documentation to ensure appropriate charging. 
• Review, assess, study, and analyze the overall coding, billing, documentation, and reimbursement system for potential compliance problems. Serve as a point of contact for reports of billing compliance concerns or potential issues. 
• Respond timely and professionally. 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 research, as needed. 
• Collaborate broadly across business and operational areas within the university to analyze and assess business processes, data, and risk controls. 
• Performs medical record audits of documentation, coding and billing for technical and professional services, 340-B Pharmacy, grant-funded research, risk adjustment, non-physician practitioner documentation (including incident-to guidelines, teaching physician guidelines, dental, and other areas as identified.) 
• Maintains communication with auditors and other relevant individuals/organizations until all identified discrepancies are resolved. 
• Analyze data/reports to identify and address trends, issues, and risk areas. 
• Participates in the development of voluntary disclosures and repayments to federal and state agencies. 
• Performs all other duties as assigned.