Remote Senior Compliance Coding Analyst - Emergency Medicine

Texas Medical Center-Houston, TX

Remote Senior Compliance Coding Analyst - Emergency Medicine

Location: Texas Medical Center-Houston, Texas

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McGovern Medical School at UTHealth Houston

Requisition #: 240001S0

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

  • 100% paid medical premiums for our full-time employees

  • Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)

  • The longer you stay, the more vacation you’ll accrue!

  • Longevity Pay (Monthly payments after two years of service)

  • Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as…

  • Free financial and legal counseling

  • Free mental health counseling services

  • Gym membership discounts and access to wellness programs

  • Other employee discounts including entertainment, car rentals, cell phones, etc.

  • Resources for child and elder care

  • Plus many more!

Position Summary:

Performs complex physician billing compliance reviews as well as for Residents, APPs (ADVANCED PRACTICE PROVIDERS-PA/NPs), internal and external Coding, and Billing staff for Emergency Medicine including our Hospitalist, Urge

Coordinates, schedules and performs coding and documentation reviews of medical/patient records to ensure provider billing practices are compliant with applicable rules and regulations.

Serves as a knowledge resource for coding and billing auditing functions and provides direction and guidance to Compliance Coding Analysts. Trains and educates new/existing providers as well as coding staff. Attends meetings.

Manages EPIC PB Edits and Requests for denial appeals. Reports review results to the Revenue Cycle Manager, Manager, and/or Medical Billing Compliance. Providers coverage/support for the Clinical Billing Manager, when needed.

Position Key Accountabilities:

  1. Responsible for coordinating, scheduling, and implementing complex physician billing compliance reviews in collaboration with the Manager, Billing Compliance.

  2. Serves as knowledge resource in issue resolution; may provide guidance for daily activities of coding analyst staff.

  3. Reviews documentation to establish compliance with teaching physician billing guidelines, evaluation and management documentation guidelines, and correct coding standards based on government and third party payer requirements.

  4. Prepares and routes monthly provider review reports.

  5. Analyzes data/reports from compliance monitoring activities to identify trends, issues and risk areas.

  6. Identifies provider specific educational needs relative to professional coding and documentation; Meets with providers to provide focused educational reviews to providers to enhance compliance.

  7. Assists Compliance Coding Analysts in ongoing educational efforts.

  8. Responds to billing and coding questions from providers, staff and administrators. Maintains tracking system for responses.

  9. Serves as senior liaison between Medical School Billing Compliance and Physician Business Services Compliance Training Specialists/Physician Educators. Communicates coding issues to Physician Business Services.

  10. Maintains effective and cooperative communication with providers, their administrative and clerical support staff and hospital medical records staff.

  11. Assists in developing department policies and procedures.

  12. Meets and maintains established continuing education, productivity and performance standards.

  13. Performs other duties as assigned.

Certification/Skills:

  1. Certified Professional Coder (CPC) or Certified Coding Specialist Physician-based (CCS-P).

  2. Effective analytical and communication skills.

  3. Extensive PC knowledge, especially in the area of word processing and spreadsheets.

Minimum Education:

Bachelor’s degree in business, health administration, health information management or relevant work experience in lieu of education.

Minimum Experience:

Five years direct experience or comparable competency in chart abstraction, ICD or CPT coding, charge documentation and charge capture resolution. Knowledge of government documentation, coding and reimbursement guidelines, PATH issues and third-party payer reimbursement practices. Experience in academic health care auditing preferred.

Additional Information:

  • Full-Time / Exempt

  • High Production - High Demand position within a dynamic department

  • Must know the differences between ER Provider versus ER facility billing and coding

  • Coding (Must be strong in E/M Provider coding)

  • Outpatient Evaluation & Management Coding

  • Outpatient Procedure Coding

  • Outpatient Diagnosis Coding

  • Modifiers

  • Resolve Coding Edits

  • 100% Code abstraction

  • Billing

  • Professional fee, appeals, cognizant of healthcare policies

  • Knowledge of RBRVS and insurance reimbursement regulations

  • Compliance

  • Pre and/or Retro Chart Audits/Reviews

  • Institutional Audits (MD Chart Audits)

  • Payor Audits

  • Fraud & Abuse - Recognize risk areas and complete follow-up

  • Conducting training for compliance

  • Miscellaneous

  • Enjoys researching to resolve issues while able to prioritize and manage time accordingly

  • Independent worker, self-motivator, quick learner and thinker

  • Ability to build reports and analyze data to report out

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.

If you are looking for a great healthcare career in Houston, visithttp://go.uth.edu/careers!

University of Texas Health Science Center at Houston (UTHealth)

Established in 1972 by The University of Texas System Board of Regents, The University of Texas Health Science Center at Houston (UTHealth) is Houston’s Health University and Texas’ resource for health care education, innovation, scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System and the U.S. Gulf Coast region, UTHealth Houston is home to schools of biomedical informatics, biomedical sciences, dentistry, nursing and public health and the John P. and Kathrine G. McGovern Medical School. UTHealth Houston includes The University of Texas Harris County Psychiatric Center, as well as the growing clinical practices UT Physicians, UT Dentists and UT Health Services. The university’s primary teaching hospitals are Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Harris Health Lyndon B. Johnson Hospital.

UTHealth Benefits

UTHealth Houston offers a comprehensive and competitive benefits package. For more information on our benefits programs please refer to the UTHealth Houston Office of Benefits Website.

https://www.uth.edu/benefits/

Equal Employment Opportunity Statement

UTHealth Houston is committed to providing equal opportunity in all employment-related activities without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, genetic information, gender identity or expression, veteran status or any other basis prohibited by law or university policy. Reasonable accommodation, based on disability or religious observances, will be considered in accordance with applicable law and UTHealth Houston policy. The University maintains affirmative action programs with respect to women, minorities, individuals with disabilities, and eligible veterans in accordance with applicable law.

UTHealthHoustonhas adopted a policy consistent with CMS regulations to protect our patients and university community from exposure to COVID-19. This policy affects all employees, residents, fellows, students, contractors, new hires, visiting scholars program participants, adjunct faculty, and volunteers who work, train, or collaborate at the John S. Dunn Behavioral Science Center.

In addition, all UTHealthHouston​​​​​​​employees who are assigned to work at a location that is subject to the affiliated partner’s hospital, clinical offices, or agency are required to abide by UTHealth’sHoustonrules and regulations, as well as the affiliate’s rules and regulations, including COVID-19 vaccination and safety requirements.

Work location is based on the needs of the department and may be adjusted.