Billing Integrity Educator

UT Southwestern Medical Center - Dallas, TX3.9

Full-timeEstimated: $44,000 - $56,000 a year
Job Number: 339072
Category: Insurance/Billing
Location: 5323 Harry Hines Blvd, Dallas, TX
Department: 700631 - Medicine & Ancillary Front End
Full/Part Time/PRN: Day Job
Regular/Temporary: Regular
Schedule: Full-time


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information


Salary Negotiable

Experience and Education

High school diploma or equivalent and five (5) years of experience in a professional billing environment with emphasis on coding, auditing and compliance responsibilities is required. Certification in one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or a Certified Medical Coder (CMC) is required. CPMA is desired. Associates degree or two years of college is desired.
Job Duties

1. Serves as a professional billing integrity leader, under supervision of Sr. Professional Billing Integrity Educator or Supervisor, 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. This may include medical record audits, invoice analysis, and review of internal reports (e.g., Charge Analyzer, Code Correct), denials, external audit findings, etc. Assists Sr. Professional Billing Integrity Educator or Supervisor with development and deployment of any action plans required.
2. Conducts standardized new provider coding and compliance training (onboarding) for physicians, advanced practice providers and other professional practitioners, in two or more service lines/divisions. Training may be conducted in an individual or group setting.
3. Performs post-onboarding pre-bill review of professional charges and follow-up with new providers to confirm understanding of procedure, modifier and diagnosis code assignment, as well as, documentation requirements to promote billing compliance. Supporting two or more service lines, with supervision by Sr. Professional Billing Integrity Educator or Supervisor.
4. Conducts increasingly independent reviews on adequacy of medical record documentation, to support the procedure, modifier and diagnosis coding of evaluation and management (E&M) services and low-moderate complexity diagnostic/therapeutic services, billed by physicians, practitioners or billing staff, in two or more service areas. Working with Sr. Professional Billing Integrity Educator or Supervisor, develops reports that summarize outcomes. Provides input on recommended corrective action plans.
5. Research coding, documentation and reimbursement policy questions or problems submitted by physicians, practitioners, supported-departments, billing staff and others, to ensure compliance with specific payer and/or government regulations. Assist Senior Billing Integrity Educator and/or supervisor with responses. Escalates issues beyond their scope to Senior Billing Integrity Educator, Supervisor or Manager.
6. In coordination with the Compliance Office, support and/or conduct Billing Compliance risk-based audits.
7. Complete charge review and follow-up EPIC work queue assignments, within department timeliness standards, under guidance of the Senior Billing Integrity Educator or Supervisor. Assists with quality assurance reviews for internal or contractor staff to verify the coding or other work is consistent and supported by regulations, University guidelines and/or MSRDP Medicine Audit Plan.
8. Assists with training for contractor staff on the use of audit software, EPIC, internal audit plan, work queue assignments, etc. as needed.

**Other Duties: Performs other duties as assigned.

UTSouthwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.