Scope of Job
Compliance Coding and Billing Analyst: 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.
Compliance Coding and Billing Manager: Responsible for the oversight of billing and coding compliance functions and activities and compliance risk assessments to ensure compliance with federal/state laws and regulations and UTRGV policies. Serves as a subject matter expert in coding regulations and leads the development and implementation of risk-based coding educational training, audit programs, facilitating educational webinars and seminars, planning and delivering effective presentations, and process improvement initiatives.
Description of Duties
Compliance Coding and Billing Analyst
- Performs monitoring and compliance reviews of medical 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.
Compliance Coding and Billing Manager
- Manages the oversight, monitoring and compliance reviews of medical billing and coding compliance activities and associated risk assessments to ensure compliance with federal/state laws and regulations and UTRGV policies.
- Serves as a subject matter expert in coding regulations and leads the development and implementation of risk-based coding educational trainings, audit programs, facilitating educational webinars and seminars, planning and delivering effective presentations, and process improvement initiatives.
- Manages, plans, organizes, and evaluates the effectiveness of compliance controls used by the area to ensure effective and efficient operations and its compliance with all applicable regulations, laws, policies, and procedures.
- Responsible for the collection of information to prepare billing compliance reports, provides supporting evidence, and conclusions, and makes recommendations for corrective measures on identified billing compliance.
- Manages and 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, evaluates and analyzes medical records, coding, billing, claims, reimbursements and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements.
- Develops, implements, and maintains coding audit strategies aligned with CMS (Centers for Medicare and Medicaid Services), OIG (Office of Inspector General), and internal health system compliance standards.
- Maintains advanced knowledge of legal, regulatory, and policy requirements related to coding and documentation.
- Monitors changes to coding methodologies, official coding guidelines, regulatory requirements, and reimbursement methodologies and ensure timely education of affected staff.
- Performs charge reviews comparing itemized bills to medical record documents to ensure appropriate charges.
- Oversees the review of electronic and manual documentation, coding, and billing systems.
- Reviews, assesses, study, and analyses 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.
- Evaluates and prepares quarterly reporting and verification through inspections and walk-throughs as assigned.
- Makes recommendations for implementation of policies and procedures related to coding and billing compliance.
- Responsible for reviewing and preparing appropriate reports for the Executive Compliance Committee and other stakeholders 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.
Supervision Received
General supervision from assigned supervisor.
Supervision Given
Direct supervision of assigned staff.
Required Education
Compliance Coding and Billing Analyst
- Bachelor’s degree in Business, IT or Health related field from an accredited university, or
- Associate’s degree in a related field with four (4) years of the required experience, or
- Education may be substituted with experience on a one-to-one basis.
Compliance Coding and Billing Manager
- Bachelor’s degree in Business, IT or Health related field from an accredited university, or
- Associate’s degree in a related field with six (6) years of the required experience, or
- Education may be substituted with experience on a one-to-one basis.
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
Compliance Coding and Billing Analyst
Preferred: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) by the American Health Information Management Association (AHIMA) or the American Academy Professional Coders (AAPC).
Compliance Coding and Billing Manager
Certified Professional Medical Auditor (CPMA), Certified Coding Specialist – Physician (CCS-P), Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) by the American Health Information Management Association (AHIMA) or the American Academy Professional Coders (AAPC).
Required Experience
Compliance Coding and Billing Analyst
Two (2) years of related billing/coding and or auditing experience. Education may be substituted with experience on a one-to-one basis
Compliance Coding and Billing Manager
Four (4) years of related billing/coding and or auditing experience. Education may be substituted with experience on a one-to-one basis.
Preferred Experience
Compliance Coding and Billing Analyst: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
04/06/2026
If Yes, Provide Grant Expiration Date
