38935BR

Extended Job Title:

Documentation & Coding Auditor

Org Level 1:

Texas Tech Unv Hlth Sci Ctr El Paso

Position Description:

Performs coding and documentation quality audits; provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities.

Requisition ID:

38935BR

Travel Required:

Up to 25%

Major/Essential Functions:

• Maintains current knowledge of billing and coding requirements, risks and billing compliance requirements. Regularly reviews JH-MAC website and Texas Medicaid policies. Demonstrate knowledge of compliance documentation and coding standards, seeking guidance from supervisor as necessary. Research payer policies to accurately and completely address billing compliance questions. Participate in coding/billing educational programs and report relevant information to supervisor. Network with peers.

• Monitors and addresses payer audits reviews. Establish process to obtain copies of government initiated audits.

• Conduct concurrent audit/review to determine possible risks and opportunities to assist in appeals.

• Assists and standards of policy development. Review and provide input during development of billing compliance standards; identify areas that may require written policies; obtain input from campus constituents on proposed billing compliance policies.

• Provides and tracks required Billing Compliance training. Schedule trainings to meet requirements under the Billing Compliance Program. Prepares PowerPoint presentations and handouts, incorporating relevant risks areas for each department. Meet with coders, administrators and others to identify problems areas for training. Conduct live training sessions and timely respond to questions providing written guidance. Track completion of mandatory training and notify departments for those who need to complete training.

• Maintains confidentiality. Marks confidential documents and e-mail as confidential and/or privilege in accordance with billing compliance and TTUHSC EP policies; stores ships and/or destroys Confidential and/or Protected Health Information in accordance with policies. Releases confidential information only with approval of Supervisor and/or Compliance Officer. Limits discussions of confidential information.

• Assists in Billing Compliance investigations. Conduct investigations of reported billing non-compliance, providing information and written reports according to establish deadlines.

• Office of Institutional Compliance (OIC) annual risk assessment/work plan. Actively participate in development of a new risk assessment and subsequent OIC work plan.

• Responsible for campus Billing Compliance Program administrative duties. Organize and maintain files in accordance with policies and procedures.

• Promptly reports vital information. Timely communicate information to faculty, staff and administrators, including an MPIP staff. Immediately communicate any known and or illegal, unethical or non-compliant conduct. Update faculty, staff and administrators or payer activity.

• Monitors corrective action. Verify that corrective action has been completed. Assist in corrective action processes, to include additional training and/or follow-up audits. Maintain log of and track corrective action plans. Follow-up to prepare written report and status of completion a corrective action. Submit to BCAC and Supervisor(s).

• Risk assessments (related to identified issues beyond OIC work plan). Conduct risk audits as directed by Supervisor.

• Prepare timely and accurate written reports of findings. Conduct follow-up education; recommend an implement, as necessary, corrective action. Document pertinent activity.

• Personally demonstrate, display, and act in accordance with TTUHSC EP’s values (Service, Respect, Accountability, Integrity, and Teamwork).

• Adhere to all TTUHSCEP policies, procedures and processes.

• Actively promote and encourage Values Based Culture to staff across the institution.

• Perform other duties. Maintain coding certification. Assist with administrative duties as directed by Supervisor(s).

Grant Funded?:

No

Minimum Hire Rate:

Compensation is commensurate upon the qualifications.

Pay Basis:

Hourly

Work Location:

El Paso

Preferred Qualifications:

• Current and active professional coding certification required from an accredited organization.

• Billing and coding experience in a multi-specialty group practice and/or academic practice setting is preferred.

• Five or more years of progressively responsible experience in a health care environment, with three of those years directly involved in coding of health care items/services.

• Managerial/supervisory and program management implementation experience strongly preferred.

• Ability to initiate administrative activities as necessary.

• Excellent oral and written communication skills.

• Ability to write and present ideas and information in a concise manner.

• Ability to work collaboratively with all individuals.

• Professional bearing, sound business judgment and persuasive skills.

• Strong problem-solving skills, self-starter, ability to function with little face-to-face, daily supervision.

• Ability to deal with stressful situations, works collaboratively to address complex and sensitive issues.

• Excellent time management skills and attention to detail.

• Ability to successfully pass a criminal background check, as well as not be listed on the HHS OIG, Texas Medicaid, GSA or any other government exclusion lists.

Campus:

HSC - El Paso

Department:

Inst Compliance Oversight Elp

Job Type:

Full Time

Pay Statement:

Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as, the institutional pay plan. For additional information, please reference the institutional pay plan on the Human Resources webpage.

Job Group:

Skilled Technicians

Shift:

Day

EEO Statement:

As an EEO/AA employer, the Texas Tech University System and its components will not discriminate in our employment practices based on an applicant’s race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information or status as a protected veteran.

Required Qualifications:

• High School graduate or equivalency and five (5) years of coding and reimbursement experience of which one (1) year may be as a coding auditor.

• Additional job-specific education may substitute for the experience.

• Active professional coding certification from an accredited organization, e.g., American Association of Professional Coders (AAPC), American Health Information Management Association (AHIMA).

• Certification to remain current during term of employment.

• Knowledge of CPT, ICD-CM, ICD-10, and HCPCS nomenclature.

Does this position work in a research laboratory?:

No

Jeanne Clery Act:

The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act is a federal statute requiring colleges and universities participating in federal financial aid programs to maintain and disclose campus crime statistics and security information. By October 1 of each year, institutions must publish and distribute their Annual Campus Security Policy & Crime Statistics Report (ASR) to current and prospective students and employees. You can locate this report through our website at: https://www.ttuhsc.edu/emergency/clery-report.aspx .