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UT Health Senior Compliance Specialist in Institutional Healthcare Billing in Texas Medical Center-Houston, Texas

Senior Compliance Specialist in Institutional Healthcare Billing

Texas Medical Center-Houston, Texas

Healthcare Support Services

McGovern Medical School at UTHealth

Requisition #: 210002HM

Position Summary:

UTHealth is looking for a Senior Compliance Specialist to work in Institutional Healthcare Billing. This employee provides mentoring, education, and technical oversight of activities related to healthcare billing compliance for faculty, residents, and staff for of all specialties. Acts as a resource for healthcare billing compliance activities across the university. Identifies trends, issues, and risk areas and recommends corrective action. Coordinates and works in collaboration with billing compliance liaisons university-wide with the goal of ensuring documentation is compliant with regulatory requirements.

The focus of this role is to function as a healthcare billing auditor. You must have experience looking for mistakes or discrepancies in how healthcare billing is coded and sent off to billing agents or patients. At least one certification in coding is required, and all applicants must have at least five years of work in this field. You must also have great written and spoken communication skills, as this employee will often have to consult with physicians, professors, and managers inside UTHealth.

This is a full time role that is eligible for all benefits from UTHealth. These include healthcare coverage as well as participcation in a pension plan run by the State of Texas. You will be officing out of our University Professional Building in the heart of the Texas Medical Center. Some hybrid of in-office hours will be mixed with remote work, but you must be able to come in for meetings and presentations on a regular basis. Candidates will need to possess excellent written and verbal communication skills.

Position Key Accountabilities:

  1. Coordinates and tracks institution-wide monitoring of healthcare billing compliance through the use of a designated computerized billing compliance auditing and risk assessment application.

  2. Analyzes healthcare billing compliance audit results based on-going billing compliance reviews and educational efforts to identify institution-wide trends, issues and risk areas; reports the results to the Assistant Vice President and Chief Compliance Officer and recommends corrective action based on audit results.

  3. Assists the Chief Compliance Officer in responding to reports of suspected non-compliance, including, but not limited to, record maintenance and assisting investigations.

  4. Assists the departmental compliance efforts across all specialties in developing, revising, and formulating policies and procedures, billing compliance risk mitigation strategies, and specialty specific coding education for providers, non-physician practitioners, and residents. Provides and presents findings at departmental meetings regarding coding and compliance issues within departments assigned.

  5. Provides in person healthcare billing compliance training for new providers, non-physician practitioners and residents, including, but not limited to appropriate use of mandated teaching physician guidelines, evaluation and management documentation guidelines, and correct coding standards based on government payer requirements. Also assists in the delivery, development, tracking, and expansion of institution-wide education through computer-based training related to coding and compliance for new healthcare providers.

  6. Formulates and delivers all in person training to new and existing departmental compliance liaisons regarding the use of the designated computerized billing compliance audit and risk assessment application. Develops supportive education tools and course material to assist with the use of the application and the supplemental reporting system.

  7. Performs multi-specialty quality assurance reviews, and disseminates information regarding individual billing provider compliance to those responsible for departmental compliance efforts.

  8. Acts as a resource for providers, practitioners, residents, and administration for queries related to coding conventions and compliance readiness.

  9. Maintains effective and cooperative communication with the clinical providers, their departmental compliance and administration personnel, and university administration.

  10. Maintains knowledge of current regulatory requirements, coding, and diagnostic procedures.

  11. Performs other duties as assigned.

Certification/Skills:

Certified Coding Professional (CPC) American Academy of Professional Coders (AAPC), or

Certified Coding Specialist - Physician-based (CCS-P) American Health Information Management Association (AHIMA).

Knowledge of government documentation, coding and reimbursement guidelines, and third-party payer reimbursement practices. Experience in academic health care auditing preferred.

Minimum Education:

Bachelor’s degree preferably in Health Administration or equivalent related experience in lieu of education.

Minimum Experience:

Five (5) years of multiple-specialty coding and compliance auditing experience; 6 years preferred.

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

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

https://www.uth.edu/benefits/benefits-summary.htm

Equal Employment Opportunity Statement

UTHealth 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 policy. The University maintains affirmative action programs with respect to women, minorities, individuals with disabilities, and eligible veterans in accordance with applicable law.

COVID-19 Protocol

As you may already know, UTHealth recently decided to take an important and necessary step to protect members of our community against COVID-19 by making COVID-19 vaccinations mandatory for all employees, residents, fellows, contractors, and volunteers. Individuals subject to the vaccination requirement must be fully vaccinated on or by January 4th, 2022. Additionally, all members of our community—including students and visitors—are required to comply with our new COVID-19 Workplace Safety Protocol, which contains masking and physical distancing requirements that applies in certain settings depending on the individual’s vaccination status.

In addition, all UTHealth 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’s rules and regulations, as well as the affiliate’s rules and regulations, including COVID-19 vaccination requirements.

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